Relevant bibliographies by topics / Epidural

Academic literature on the topic 'Epidural'

Author: Grafiati
Published: 4 June 2021
Last updated: 31 January 2023

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Contents

  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Journal articles on the topic "Epidural":

1

Leighton, Barbara L., Stephen H. Halpern, and Donna B. Wilson. "Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women." Anesthesiology 90, no. 4 (April 1, 1999): 1039–46. http://dx.doi.org/10.1097/00000542-199904000-00017.

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Background Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. Methods At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. Results Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. Conclusions Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.
2

Manchikanti, Laxmaiah. "A Prospective Evaluation of Complications of 10,000 Fluoroscopically Directed Epidural Injections." Pain Physician 2;15, no. 2;3 (March 14, 2012): 131–40. http://dx.doi.org/10.36076/ppj.2012/15/131.

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Background: Among the multiple modalities of treatments available in managing chronic spinal pain, including surgery and multiple interventional techniques, epidural injections by various routes, such as interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, and percutaneous adhesiolysis are common. Even though the complications of fluoroscopically directed epidural injections are fewer than blind epidural injections, and have better effectiveness, multiple complications have been reported in scattered case reports, with only minor complications in randomized or non-randomized studies and systematic reviews. Thus, prospective studies with large patient series are essential to determine the types and incidences of complications. Study Design: A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009. Setting: A private interventional pain management practice, a specialty referral center in the United States. Objectives: To assess the complication rate of fluoroscopically directed epidural injections. Methods: This study was carried out over a period of 20 months and included over 10,000 procedures: 39% caudal epidurals, 23% cervical interlaminar epidurals, 14% lumbar interlaminar epidurals, 13% lumbar transforaminal epidurals, 8% percutaneous adhesiolysis, and 3% thoracic interlaminar epidural procedures. All of the interventions were performed under fluoroscopic guidance in an ambulatory surgery center by one of 3 physicians. The complications encountered during the procedure and postoperatively were prospectively evaluated. Outcomes Assessment: Measurable outcomes employed were intravascular entry of the needle, profuse bleeding, local hematoma, bruising, dural puncture and headache, nerve root or spinal cord irritation with resultant injury, infectious complications, vasovagal reactions, and facial flushing. Results: Intravascular entry was higher for adhesiolysis (11.6%) and lumbar transforaminal (7.9%) procedures compared to other epidurals which ranged from 0.5% for lumbar, 3.1% for caudal, 4% for thoracic, and 4.1% for cervical epidurals. Dural puncture was observed in a total of 0.5% of the procedures with 1% in the cervical region, 1.3% in the thoracic region, 0.8% with lumbar interlaminar epidurals, and 1.8% with adhesiolysis. Limitations: Limitations of this study include a single-center study even though it included a large number of patients. Conclusion: This study illustrates that major complications are rare and minor side effects are common. Key words: Spinal pain, epidural injections, caudal epidural, interlaminar epidural, transforaminal epidural, percutaneous adhesiolysis, complications, and steroids.
3

Tuuli, Methodius, Molly Stout, Candice Woolfolk, Kimberly Roehl, George Macones, Alison Cahill, and Adam Lewkowitz. "Epidurals and the Modern Labor Curve: How Epidural Timing Impacts Fetal Station during Active Labor." American Journal of Perinatology 35, no. 05 (December 29, 2017): 421–26. http://dx.doi.org/10.1055/s-0037-1617457.

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Objective The objective of this study was to estimate epidural timing's impact on fetal station during active labor. Study Design This secondary analysis of a single-institution prospective cohort study included all term singleton pregnancies, stratified by parity. Those with early epidurals (placed at <6 cm) were compared with those with late epidurals (placed at ≥6 cm). The primary outcome was median fetal station from 6 to 10 cm. Secondary outcomes included rate of prolonged first or second stage of labor (>95%). Multivariable logistic regression adjusted for labor type. Results Among 7,647 women, 3,434 were nulliparous (2,983 with early epidurals and 451 with late epidurals) and 4,213 multiparous (3,141 with early epidurals and 1,072 with late epidurals). Interquartile ranges (IQRs) suggested fetal station at 6 cm was likely lower among those with early epidurals (nulliparous: median head station −1 [IQR: −1 to 0] for early epidural vs. −1 [IQR: −2 to 0] for late epidural, p < 0.01; multiparous: −1 (IQR: −2 to 0] for early epidural vs. −1 [IQR: −3 to −1] for late epidural, p < 0.01). Early epidurals were not associated with increased risk of prolonged first stage, but among nulliparous were associated with decreased risk of prolonged second stage (adjusted odds ratio: 0.66 [95% confidence interval: 0.44–0.99]). Conclusion Early epidurals were associated with lower fetal station in active labor but not prolonged first stage.
4

Bernards, Christopher M., Danny D. Shen, Emily S. Sterling, Jason E. Adkins, Linda Risler, Brian Phillips, and Wolfgang Ummenhofer. "Epidural, Cerebrospinal Fluid, and Plasma Pharmacokinetics of Epidural Opioids (Part 1)." Anesthesiology 99, no. 2 (August 1, 2003): 455–65. http://dx.doi.org/10.1097/00000542-200308000-00029.

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Background The pharmacokinetics of epidurally administered drugs has been the subject of many studies, yet drug concentration in the epidural space has never been measured. This study was undertaken to characterize the epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidurally administered opioids on the basis of measurement of drug concentration in each of these compartments after epidural administration. Methods Morphine plus alfentanil, fentanyl, or sufentanil were administered epidurally in anesthetized pigs. Microdialysis was used to sample the epidural space and the cerebrospinal fluid for measurement of opioid concentration over time. Plasma samples were obtained from the central venous plasma and the epidural venous plasma. These data were used to calculate relevant pharmacokinetic parameters, including mean residence time, elimination half-lives, areas under the concentration versus time curves, clearance, and volume of distribution for each opioid in each compartment. Results Some of the more important findings were that the cerebrospinal fluid and plasma pharmacokinetics of the opioids did not parallel their epidural pharmacokinetics and that their hydrophobic character governed multiple aspects of their lumbar epidural pharmacokinetics. Conclusions The findings indicate that the spinal pharmacokinetics of these drugs are complex and, in some ways, counterintuitive. Also, the bioavailability of opioids in the cerebrospinal fluid and epidural space is determined primarily by their hydrophobicity, with less hydrophobic drugs having greater bioavailability.
5

McLaren, Steve, Megan Hughes, Catherine Sheehan, and Jagdish Sokhi. "A guide to epidural management." British Journal of Hospital Medicine 81, no. 1 (January 2, 2020): 1–7. http://dx.doi.org/10.12968/hmed.2019.0174.

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Epidural analgesia is a key component in the management of inpatient pain relief, particularly in surgical and trauma patients, and those with comorbidities. When used appropriately epidurals can decrease a patient's opiate consumption, as well as reducing the risk of adverse cardiorespiratory outcomes. To non-anaesthetists, or those not versed in their usage, epidurals can appear complex and intimidating, and the potential complications, although rare, can be catastrophic if not picked up on in a timely fashion. This article demystifies the epidural for hospital clinicians, looking at the anatomy and pharmacology, helping to identify patients who may benefit from epidural analgesia, highlighting some common pitfalls and questions posed by nursing staff, and providing a framework via which junior clinicians can detect, manage and appropriately escalate epidural-related problems and complications. Epidural analgesia is an invasive and high-risk intervention; as such it should always be managed by a multidisciplinary team, including anaesthesia and acute pain services.
6

Bernards, Christopher M., Danny D. Shen, Emily S. Sterling, Jason E. Adkins, Linda Risler, Brian Phillips, and Wolfgang Ummenhofer. "Epidural, Cerebrospinal Fluid, and Plasma Pharmacokinetics of Epidural Opioids (Part 2)." Anesthesiology 99, no. 2 (August 1, 2003): 466–75. http://dx.doi.org/10.1097/00000542-200308000-00030.

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Background The ability of epinephrine to improve the efficacy of epidurally administered drugs is assumed to result from local vasoconstriction and a consequent decrease in drug clearance. However, because drug concentration in the epidural space has never been measured, our understanding of the effect of epinephrine on epidural pharmacokinetics is incomplete. This study was designed to characterize the effect of epinephrine on the epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidurally administered opioids. Methods Morphine plus alfentanil, fentanyl, or sufentanil was administered epidurally with and without epinephrine (1:200,000) to pigs. Opioid concentration was subsequently measured in the epidural space, central venous plasma, and epidural venous plasma, and these data were used to calculate relevant pharmacokinetic parameters. Results The pharmacokinetic effects of epinephrine varied by opioid and by sampling site. For example, in the lumbar epidural space, epinephrine increased the mean residence time of morphine but decreased that of fentanyl and sufentanil. Epinephrine had no effect on the terminal elimination half-life of morphine in the epidural space, but it decreased that of fentanyl and sufentanil. In contrast, in the lumbar intrathecal space, epinephrine had no effect on the pharmacokinetics of alfentanil, fentanyl, or sufentanil, but it increased the area under the concentration-time curve of morphine and decreased its elimination half-life. Conclusions The findings indicate that the effects of epinephrine on the spinal pharmacokinetics of these opioids are complex and often antithetical across compartments and opioids. In addition, the data clearly indicate that the pharmacokinetic effects of epinephrine in spinal "compartments" cannot be predicted from measurements of drug concentration in plasma, as has been assumed for decades.
7

Manchikanti, Laxmaiah. "Assessment of the Growth of Epidural Injections in the Medicare Population from 2000 to 2011." Pain Physician 4;16, no. 4;7 (July 14, 2013): E349—E364. http://dx.doi.org/10.36076/ppj.2013/16/e349.

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Background: Among the many diagnostic and therapeutic interventions available for the management of chronic pain, epidural steroid injections are one of the most commonly used modalities. The explosive growth of this technique is relevant in light of the high cost of health care in the United States and abroad, the previous literature assessing the effectiveness of epidural injections has been sparse with highly variable outcomes based on technique, outcome measures, patient selection, and methodology. However, the recent assessment of fluoroscopically directed epidural injections has shown improved evidence with proper inclusion criteria, methodology, and outcome measures. The exponential growth of epidural injections is illustrated in multiple reports. The present report is an update of the analysis of the growth of epidural injections in the Medicare population from 2000 to 2011 in the United States. Study Design: Analysis of utilization patterns of epidural procedures in the Medicare population in the United States from 2000 to 2011. Objectives: The primary purpose of this assessment was to evaluate the use of all types of epidural injections (i.e., caudal, interlaminar, and transforaminal in the lumbar, cervical, and thoracic regions) with an assessment of specialty and regional characteristics. Methods: This assessment was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. Results: Epidural injections in Medicare beneficiaries increased significantly from 2000 to 2011. Overall, epidural injections increased 130% per 100,000 Medicare beneficiaries with an annual increase of 7.5%. The increases per 100,000 Medicare recipients were 123% for cervical/ thoracic interlaminar epidural injections; 25% for lumbar/sacral interlaminar, or caudal epidural injections; 142% for cervical/thoracic transforaminal epidural injections; and 665% for lumbar/ sacral transforaminal epidural injections. The use of epidurals increased 224% in the radiologic specialties (interventional radiology and diagnostic radiology) and 145% in psychiatric settings, whereas and physical medicine and rehabilitation physicians’ use of epidurals increased 520%. Limitations: Study limitations include lack of inclusion of Medicare Advantage patients. In addition, the statewide data is based on claims which may include the contiguous or other states. Conclusions: Epidural injections in Medicare recipients increased significantly. The growth was significant for some specialties (radiology, physical medicine and rehabilitation, and psychiatry) and for certain procedures (lumbosacral transforaminal epidural injections). Key words: Spinal pain, interventional pain management, epidural injections, caudal epidural, lumbar epidural, cervical epidural, cervical transforaminal, lumbar transforaminal
8

Stark, Mary Ann. "Exploring Women’s Preferences for Labor Epidural Analgesia." Journal of Perinatal Education 12, no. 2 (March 1, 2003): 16–21. http://dx.doi.org/10.1891/1058-1243.12.2.16.

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The purpose of this study was to explore demographic factors related to women’s prenatal preferences for using an epidural during labor. Women recruited from prenatal classes provided data for this descriptive correlational study. Women with the most education, income, and parity indicated greatest preference for epidural analgesia. Thus, these women may be comfortable with the technology and most likely to be willing to pay for epidurals and to select care providers who provide epidural anesthesia. In this sample, prenatal preference for an epidural was not predictive of actual use, although it has been shown to be predictive in previous research.
9

Kamiya, Yoshinori, Tatsuaki Kikuchi, Gaku Inagawa, Hiroshi Miyazaki, Masashi Miura, Satoshi Morita, and Takahisa Goto. "Lidocaine Concentration in Cerebrospinal Fluid after Epidural Administration." Anesthesiology 110, no. 5 (May 1, 2009): 1127–32. http://dx.doi.org/10.1097/aln.0b013e31819daf15.

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Background In this study, lidocaine concentrations in cerebrospinal fluid (CSF) at different interspaces were measured with or without preceding spinal anesthesia, 10 min after epidural injection of lidocaine, to investigate the effects of preceding meningeal puncture on CSF concentrations of epidurally administered local anesthetic. Methods Sixty patients scheduled to receive combined spinal-epidural anesthesia were randomly allocated to receive either spinal anesthesia first (group CSEA) or epidural lidocaine first (group Epi). Each group was divided into three subgroups in which the site of epidural cannulation and spinal tap were separated by one, three, or five interspaces (sets I, II, and III, respectively). CSF was collected from the L4-L5 interspace 10 min after 10 ml lidocaine, 1%, was administered epidurally. In group Epi, CSF was collected after epidural administration of lidocaine and before spinal anesthesia. In group CSEA, spinal anesthesia was performed at the L3-L4 interspace after epidural cannulation and epidural lidocaine was administered postoperatively, after which CSF was sampled. Results Lidocaine concentrations in CSF were significantly higher with increasing proximity of epidural injection site to CSF collection site in both groups. There were no significant differences in CSF lidocaine concentrations between group CSEA and group Epi in set I, although lidocaine concentrations were significantly higher in group CSEA set II and III patients. Conclusion Lidocaine concentration in CSF was similar with or without preceding meningeal puncture beneath the epidural administration site.
10

Davis, Stephanie, and Samuel Hird. "Intermittent epidural boluses vs continuous epidural infusion for labour analgesia: which is superior?" British Journal of Hospital Medicine 82, no. 5 (May 2, 2021): 1–2. http://dx.doi.org/10.12968/hmed.2020.0704.

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Epidurals are considered the gold standard for labour analgesia. The possibility of newer pumps reducing staff workload has reignited interest in the advantages of the intermittent bolus technique, but is this superior to a continuous epidural infusion?
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Journal articles Dissertations / Theses Books

Dissertations / Theses on the topic "Epidural":

1

HEBERT, NATHALIE. "Hematome epidural apres infiltration epidurale ou intradurale." Paris 6, 2001. http://www.theses.fr/2001PA062044.

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2

Ashab, Hussam Al-Deen. "Ultrasound guidance for epidural anesthesia." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44306.

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We propose an augmented reality system to automatically identify lumbar vertebral levels and the lamina region in ultrasound-guided epidural anesthesia. Spinal needle insertion procedures require careful placement of a needle, both to ensure effective therapy delivery and to avoid damaging sensitive tissue such as the spinal cord. An important step in such procedures is the accurate identification of the vertebral levels, which is currently performed using manual palpation with a reported success rate of only 30%. In this thesis, we propose a system using a trinocular camera which tracks an ultrasound transducer during the acquisition of a sequence of B-mode images. The system generates a panorama ultrasound image of the lumbar spine, automatically identifies the lumbar levels in the panorama image, and overlays the identified levels on a live camera view of the patient’s back. Several experiments were performed to test the accuracy of vertebral height in panorama images, the accuracy of vertebral levels identification in panorama images, the accuracy of vertebral levels identification on the skin, and the impact on accuracy with spine arching. The results from 17 subjects demonstrate the feasibility of the approach and capability of achieving an error within a clinically acceptable range for epidural anesthesia. The overlaid marks on the screen are used to assist locating needle puncture site. Then, an automated slice selection algorithm is used to guide the operator positioning a 3D transducer such that the best view of the target anatomy is visible in a predefined re-slice of the 3D ultrasound volume. This re-slice is used to observe, in real time, the trajectory of a needle attached to the 3D transducer, towards the target. The method is based on Haar-like features and AdaBoost learning algorithm. We have evaluated the method on a set of 32 volumes acquired from volunteer subjects by placing the 3D transducer on L1-L2, L2-L3, L3-L4 and L4- L5 interspinous gaps on each side of the lumbar spine. Results show that the needle insertion plane can be identified with a root mean square error of 5.4 mm, accuracy of 99.6%, and precision of 78.7%.
3

Holgado, Pascual Carmen María. "RESULTADO DEL PARTO CON ANALGESIA EPIDURAL: ESTUDIO OBSERVACIONAL DE COHORTES COMPARANDO PERFUSIÓN EPIDURAL CONTINUA CON BOLO INTERMITENTE PROGRAMADO MÁS ANALGESIA EPIDURAL CONTROLADA POR LA PACIENTE." Doctoral thesis, Universitat Rovira i Virgili, 2020. http://hdl.handle.net/10803/670708.

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ANTECEDENTS: L'evidència científica mostra que el bolo epidural intermitent programat (PIEB) per a l'analgèsia del treball de part aconsegueix bons resultats obstètrics. Després d'implementar el nostre protocol institucional per a l'analgèsia epidural, comparem PIEB + analgèsia epidural controlada per la pacient (PCEA) versus perfusió epidural contínua (PEC). MÈTODES: En un estudi de cohort observacional, comparem PEC amb ropivacaïna a l'0,2% + bolo inicial de fentanil de 100 mg versus PIEB+PCEA amb ropivacaïna a l'0,1% + fentanil 2 mg/ml en dones primípares. El objectiu principal va ser el tipus de part. Els objectius secundaris van ser la durada de la segona etapa del treball de part i les dosis totals de ropivacaïna i fentanil. Altres resultats estudiats al grup PIEB+PCEA, van ser: bloqueig motor, ús de PCEA i bolos de rescat, mobilitat materna i satisfacció materna. L'anàlisi estadística univariant es va realitzar mitjançant la prova de χ², anàlisi de variància o prova no paramètrica de Kruskal-Wallis. L'anàlisi multivariant es va realitzar mitjançant anàlisi de regressió logística múltiple. RESULTATS: 221 pacients van completar l'estudi (PEC116; PIEB+PCEA 105). La regressió logística múltiple va mostrar que el grup PIEB+PCEA va tenir significativament menys cesàries [PEC (14%) vs. PIEB + PCEA (5%), p = 0.015] i menys parts instrumentats, després de corregir els factors de confusió [OR = 0.49; IC de el 95%: 0,27-0,89]. La segona etapa del part no va mostrar diferència estadísticament significativa entre els grups. La dosi total de ropivacaïna va ser significativament menor amb PIEB+PCEA. No hi va haver relació entre el bloqueig motor lleu i un major ús de PCEA en el grup PIEB+PCEA. El tipus de part i la durada de la segona etapa del part tampoc es van veure influenciats pel bloqueig motor. La satisfacció materna va ser alta. CONCLUSIONS: PIEB+PCEA ofereix avantatges obstètriques i analgèsiques sobre PEC en la pràctica clínica diària.
ANTECEDENTES: La evidencia científica ha mostrado que el bolo epidural intermitente programado (PIEB) para la analgesia del trabajo de parto logra buenos resultados obstétricos. Después de implementar nuestro protocolo institucional para la analgesia epidural, comparamos PIEB + analgesia epidural controlada por la paciente (PCEA) versus perfusión epidural continua (PEC). MÉTODOSː En un estudio de cohorte observacional, comparamos PEC con ropivacaína al 0,2% + bolo inicial de fentanilo de 100 μg versus PIEB+PCEA con ropivacaína al 0,1% + fentanilo 2 μg/ml en mujeres primíparas. El objetivo principal fue el tipo de parto. Los objetivos secundarios fueron la duración de la segunda etapa del parto y las dosis totales de ropivacaína y fentanilo. Otros objetivos en el grupo PIEB+PCEA fueron: bloqueo motor, uso de PCEA y bolo de rescate, movilidad materna y satisfacción materna. El análisis estadístico univariante se realizó mediante la prueba de χ², análisis de varianza o prueba no paramétrica de Kruskal-Wallis. El análisis multivariante se realizó mediante análisis de regresión logística múltiple. RESULTADOSː 221 pacientes completaron el estudio (PEC116; PIEB+PCEA 105). La regresión logística múltiple mostró que el grupo PIEB+PCEA tuvo significativamente menos cesáreas [PEC (14%) vs. PIEB+PCEA (5%), p = 0.015] y menos partos instrumentales, después de corregir los factores de confusión [OR = 0.49; IC del 95%: 0,27 a 0,89]. La diferencia en la segunda etapa del parto no fue estadísticamente significativa entre los grupos. La dosis total de ropivacaína fue significativamente menor con PIEB+PCEA. No hubo relación entre el bloqueo motor leve y un mayor uso de PCEA en el grupo PIEB+PCEA. El modo de parto y la duración de la segunda etapa del parto tampoco se vieron influenciados por el bloqueo motor. La satisfacción materna fue alta. CONCLUSIONESː PIEB+PCEA ofrece ventajas obstétricas y analgésicas sobre PEC en la práctica clínica diaria.
BACKGROUND: Scientific evidence shows that programmed intermittent epidural bolus (PIEB) for labour analgesia achieves good obstetric outcomes. After implementing our institutional standard for epidural analgesia, we compared PIEB + patient-controlled epidural analgesia (PCEA) versus continuous epidural infusion (CEI). METHODSː In an observational cohort study, we compared CEI with 0.2% ropivacaine + 100-μg fentanyl initial bolus versus PIEB+PCEA with 0.1% ropivacaine + 2 μg/ml fentanyl in primiparous women. The primary outcome was mode of delivery. Secondary outcomes were duration of the second stage of labour and total ropivacaine and fentanyl doses. Other outcomes, in the PIEB+PCEA group only, were motor block, use of PCEA and rescue bolus, maternal mobility and maternal satisfaction. Univariate statistical analysis was performed using the χ²-test, analysis of variance or nonparametric Kruskal-Wallis test. Multivariate analysis was performed using multiple logistic regression analysis. RESULTSː 221 patients completed the study (CEI 116; PIEB+PCEA 105). Multiple logistic regression showed that the PIEB+PCEA group had significantly fewer caesarean sections [CEI (14%) vs. PIEB+PCEA (5%), p=0.015] and instrumental deliveries, after correcting for confounders [OR = 0.49; 95% CI: 0.27–0.89]. The second stage of labour did not significantly differ between groups. Total ropivacaine dose was significantly lower with PIEB+PCEA. There was no relationship between mild motor block and increased use of PCEA in the PIEB+PCEA group. Mode of delivery and duration of the second stage of labour were not influenced by motor block either. Maternal satisfaction was high. CONCLUSIONSː PIEB+PCEA offers obstetric and analgesic advantages over CEI in daily clinical practice
4

VILLELA, Ana Carolina Vasques. "Anestesia epidural toracolombar com lidocaína a 2% ou lidocaína hiperbárica a 5% pelo uso de cateter epidural totalmente implantado em cães." Universidade Federal de Goiás, 2012. http://repositorio.bc.ufg.br/tede/handle/tde/886.

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A anestesia local se popularizou na medicina veterinária no século XX, mas alguns de seus recursos, como o cateter epidural e as soluções hiperbáricas, bastante utilizados no homem atualmente ainda são pouco estudados e aplicados em animais. Em seguida, outro estudo verificou a qualidade da anestesia epidural toracolombar com lidocaína a 2% ou hiperbárica a 5% e a influência do decúbito e o do tempo de permanência do cateter epidural na qualidade deste bloqueio. Para isso foram usados sete cães machos, adultos, pesando 12,76 +/-2,59 kh. Com os animais até o espaço T13-L1, tendo seu dispositivo sepultado no tecido subcutâneo. Em seguida, administrou-se 4 mg/kg de lidocaína isobárica a 2% com os animais em posição quadrupedal(IQ4) ou em decúbito lateral (IL4); 3 mg/kg de lidocaína hiperbárica a 5% em posição quadrupedal (HQ3) ou em decúbito lateral (HL3); e 4 mg/kg de lidocaína hiperbárica a 5% em posição quadupedal (HQ4) ou em decúbito lateral (HL4). Foram avaliadas a viabilidade da técnica de implantação; a ocorrência de complicações após a implantação ou retirada do cateter epidural; o tempo de permanência do cateter epidural; os efeitos da administração de lidocaína a 2% ou hiperbárica a 5% sobre a FC, , PAS, SPO2 e TR; a a qualidade do bloqueio anestésico (latência, extensão, simetria e duração do bloqueio anestésico); influência do decúbito e do tempo de permanência do cateter na qualidade do bloqueio anestésico. A implantação do cateter epidural foi viável e isenta de complicações; houve redução significativa somente nos valores de e TR em relação ao valor basal nos grupos IQ4, IL4, HQ3, HL3,HQ4. Não foram observadas diferenças significativas na FC, PAS, SPO2, latência, duração e extensão do bloqueio entre os grupos. O decúbito não influenciou significativamente a qualidade do bloqueio. O tempo de permanência do cateter no espaço epidural influenciou significativamente a duração máxima do bloqueio sensitivo. Em conclusão, o modelo descrito para implantação do cateter epidural é viável, porém o tempo que o cateter permaneceu no espaço epidural influenciou a duração do bloqueio anestésico e a lidocaína hiperbárica a 5% não mostrou vantagens em relação ao uso da lidocaína isobárica a 2% na anestesia epidural toracolombar.
5

Ponne, Sanja. "Epidural vid förlossning : Bidrar epidural efter förlossningen till framtida ryggproblem samt ökar den risken för kejsarsnitt." Thesis, Umeå universitet, Kemiska institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-88870.

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Tran, Denis. "Instrumentation and ultrasound for epidural anesthesia." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27488.

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Lumbar epidural anesthesia is used for alleviating the pain of labor and for surgery. Here, a catheter is threaded through a Tuohy needle that is traditionally inserted using the loss-of-resistance technique to confirm entry into the epidural space. This research begins with a study of the loss-of-resistance through instrumentation. Sensors measure 1)the force applied at the plunger by the anesthesiologist, 2)the pressure at the needle tip and 3)the position of the plunger relative to the syringe. The “feel” in different tissues is quantified for porcine subjects ex vivo and human subjects in vivo. A vertebra counting protocol is developed to identify the desired vertebral interspaces. Ultrasound is then used to measure anatomical distances such as the distance between the skin and ligamentum flavum and surrogate measures compared to the actual needle insertion depth. Good correlation is only found between skin-to-ligamentum flavum and the actual needle insertion depth. Next, a real-time in-plane ultrasound technique is developed with a needle guide fixing the needle trajectory to the ultrasound transducer. This allows the anesthesiologist to guide the insertion of the epidural needle as an “aim-and-insert” method. In 18 of 19 subjects, the procedure was successfully performed. The key limitation of ultrasound in this application is the image quality that inhibits interpretation of the images. A median-based spatial compounding with warping is performed to align the anatomical features of different beam-steered images and combine them to obtain a single enhanced image. This method is tested on image sets of phantoms and lumbar anatomy of 23 human subjects and shows a significant improvement in noise reduction and clarity. Another limitation is the interpretation of ultrasounds of the spinal anatomy requires understanding of ultrasound. An automatic detection algorithm is developed based on the experienced sonographer’s method of detecting the ligamentum flavum in ultrasounds. This novel method is tested on ultrasounds of the lumbar anatomy in 20 human subjects and shows the method successfully detects the ligamentum flavum in 34 of 39 cases. The main conclusion is that specialized ultrasound tools and protocols are needed to accomodate the range of patients and levels of experience of practitioners.
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Mastrocinque, Sandra. "Avaliação do emprego do tramadol epidural ou sistêmico e da morfina epidural em cadelas submetidas à ovariohisterectomia." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-28092006-173042/.

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O objetivo deste estudo foi o de comparar o emprego do tramadol, por via epidural ou sistêmica, com a morfina por via epidural, para controle da dor pós-operatória em cadelas submetidas à ovariohisterectomia, assim como determinar a ação dos agentes sobre o sistema cardiorespiratório e ocorrência de efeitos adversos. Para tanto, foram utilizadas 40 cadelas, distribuídas, aleatoriamente, em 4 grupos de 10 animais cada. O grupo 1 recebeu 2 /kg de tramadol por via epidural, o grupo 2 recebeu 2 mg/kg de tramadol por via intramuscular, o grupo 3 foi tratado com 0,1 mg/kg de morfina por via epidural e o grupo 4, determinado como controle, recebeu solução salina. Os fármacos foram administrados 30 minutos antes da indução anestésica, sendo o estudo caracterizado como prospectivo, clínico, tipo cego. Os animais foram pré-medicados com acepromazina, a indução anestésica realizada com propofol e o isofluorano foi empregado para manutenção da anestesia. As variáveis mensuradas foram: analgesia, sedação, freqüências cardíaca e respiratória, pressão arterial, concentração de isofluorano e dióxido de carbono no ar expirado, saturação periférica da oxihemoglobina, pH e gases sangüíneos, cortisol sérico e catecolaminas plasmáticas. Os animais foram avaliados por período de 24 horas após administração do fármaco analgésico. Os resultados foram submetidos à análise de variância, onde valores de P<0,05 foram considerados significantes. Não houve diferença entre os tratamentos com relação aos parâmetros de oxigenação, ventilação e cardiovasculares com exceção da pressão diastólica, que no grupo tratado com morfina apresentou menor valor que os demais grupos 6 horas após a administração dos analgésicos. Este grupo apresentou ainda menores escores de dor em vários momentos de avaliação, além de diminuir o requerimento de isofluorano em relação aos demais grupos aos 10 minutos de anestesia e aos 30 minutos, em comparação com o grupo controle, e menor valor de cortisol sérico 2 horas após a administração do fármaco analgésico em comparação ao grupo tratado com tramadol intramuscular e controle. Os grupos tratados com morfina epidural e tramadol epidural apresentaram menores valores de epinefrina que o grupo que recebeu tramadol intramuscular 2 horas após administração do agente analgésico. Os animais tratados com morfina não necessitaram medicação resgate durante o decorrer do estudo. Com base nos resultados obtidos, pode-se concluir que o emprego do tramadol epidural em cães é técnica segura, livre de efeitos adversos no sistema cardiorespiratório, porém o tratamento com morfina epidural foi superior a este e aos demais grupos com relação à qualidade da analgesia, sem apresentar efeitos adversos importantes
The aim of this study was to compare epidural or systemic tramadol and morphine to control postoperative pain in bitches submitted to ovariohysterectomy and to determine the effects of treatments on cardio and respiratory systems as well as side effects. Forty female dogs were randomly divided into four groups. Group 1 received 2 mg/kg of epidural tramadol, group 2 received 2 mg/kg of intramuscular tramadol, group 3 received 0,1 mg/kg of epidural morphine and group 4 as the control group, received saline solution. Treatments were administered 30 minutes before the induction of anesthesia and study was a prospective blinded clinical trial. Animals were premedicated with acepromazine, and anesthesia was induced with propofol. Isoflurane was used for the maintenance of anesthesia. Variables measured were: analgesia and sedation, cardiac and respiratory rates, arterial blood pressure, end-tidal isoflurane and carbon dioxide, oxyhemoglobin saturation, plasma catecholamines, serum cortisol, pH and blood gases. Patients were monitored for 24 hours after the administration of the analgesic agents. Data were submitted to analysis of variance. Values of p <0,05 were considered significant. There were no differences between groups with regard to oxygenation, ventilation and cardiovascular variables except for diastolic blood pressure which showed lower values in the morphine-treated group compared to other groups at six hours of evaluation, as well as lower pain scores at several evaluation moments. Rescue analgesia was not needed in the morphine group and the isoflurane concentration was significantly lower in relation to the other groups at 10 minutes of anesthesia, and at 30 minutes of anesthesia in relation to the control group. The epidural morphine group showed lower cortisol value at 2-hour evaluation as compared to intramuscular tramadol and control groups. The epidural tramadol and morphine groups had lower epinephrine value than intramuscular tramadol group. Based on the results of this study it can be concluded that epidural tramadol is a safe analgesia technique for dogs, free of undesirable effects, although epidural morphine was more effective than other groups without side effects
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Larsen, Kim M. "COMPARISON OF EPIDURAL AND INTRAVENOUS FENTANYL PATIENT-CONTROLLED ANALGESIA AFTER CESAREAN SECTION UNDER EPIDURAL ANESTHESIA WITH CHLOROPROCAINE." VCU Scholars Compass, 1997. https://scholarscompass.vcu.edu/etd/5134.

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This study compared two methods of postcesarean fentanyl patient- controlled analgesia (PCA). Fentanyl was administered intravenously (PCAI) or epidurally (PCAE) following cesarean section under epidural chloroprocaine anesthesia. Twenty-one ASA I and II parturients were randomly assigned to receive fentanyl PCAI (n = 9) or PCA (n = 12). At surgical completion fentanyl 1.0 mcg/kg was given and the PCA initiated with a dose of 30 mcg, a lockout interval of 10 minutes, a maximum dose of 180 mcg/hr, and no basal rate. Data were collected over 24 hours including visual analog scale (VAS) pain scores, plasma fentanyl levels, total fentanyl usage, and side effects. Surgical time was significantly longer for the PCA, group (p = 0.0213). There was no difference in VAS scores until 24 hours when the PCAE group’s were significantly lower (p = 0.0295). The PCAE group almost always had lower VAS scores. Total fentanyl usage was significantly lower for the PCAE group (p = 0.050). There was no significant difference in plasma fentanyl levels, side effects, or patient satisfaction. The data revealed that both methods provided adequate postoperative analgesia and epidural fentanyl provided both local and systemic mediated analgesia.
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Gering, Ana Paula [UNESP]. "Avaliação de duas doses de lidocaína, administradas à altura da primeira vértebra lombar sobre a analgesia trans-cirúrgica e parâmetros cardiorrespiratórios em cadelas submetidas à ovariohisterectomia." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/88968.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
A anestesia epidural, quando comparada à anestesia geral, apresenta algumas vantagens como redução dos custos, minimização dos riscos anestésicos por ocasionar poucas alterações respiratórias e cardiovasculares. Mas tem sido utilizada basicamente para cirurgias no membro posterior e inguinais já que o anestésico local quando administrado no espaço compreendido entre a sétima vértebra lombar e a primeira vértebra sacral proporciona bloqueio máximo até a quarta vértebra lombar. Uma alternativa para bloqueios mais craniais é a utilização do cateter epidural. Tal estudo avaliou, comparativamente os efeitos de duas doses de lidocaína (4 e 6 mg/Kg) administradas por via epidural na altura da primeira vértebra lombar em cadelas submetidas à ovariohisterectomia. Foram utilizadas 16 cadelas SRD, pesando entre 4 e 20 Kg e entre 1 e 6 anos. Todas receberam butorfanol e etomidato, ambos por via intravenosa nas doses de 0,4 mg/Kg e 2 mg/Kg respectivamente. Foram avaliados parâmetros cardiovasculares, hemogasométricos, ventilometricos e relacionados à analgesia. Os parâmetros fisiológicos avaliados não apresentaram diferença entre os grupos em com o uso de diferentes doses de lidocaína. Relativamente à analgesia, 25% dos animais do G4 apresentaram escore de dor considerado insuficiente. Contudo conclui-se que as duas doses de lidocaína, depositadas na altura da primeira vértebra lombar, não interferem nos parâmetros ventilométricos, hemogasométricos e cardiovasculares. E a dose de 6 mg/Kg determina melhor analgesia que a de 4 mg/Kg
Epidural anesthesia compared to general anesthesia has some advantages such as reducing cost, minimizing the risks of anesthesia by causing fewer respiratory and cardiovascular changes. But it has been used primarily for surgery in the posterior limb and inguinal as the local anesthetic when administered in the space between the seventh lumbar and first sacral vertebra provides maximum block until the fourth lumbar vertebra. An alternative to more bloks cranial is the use of epidural catheter. This study evaluated the comparative effects of two doses of lidocaine (4 and 6 mg/Kg) administered epidurally at the time of the first lumbar vertebra en bitches submitted to ovariohisterectomy. !6 mongrel dogs were used, weighing between 4 and 20 Kg ande between 1 and 6 years old. All received butorphanos and etomidate, both intravenously ins doses of 0,4mg/Kg to 2 mg/Kg respectively. We assessed cardiovascular, blood gas ventilometric and analgesia. The physiological parameters evaluated did not differ between the groups using different doses of lidocaine. For analgesia, 25% of animals in G4 had a pain score considered insufficient. However, it is conclused that two doses os lidocaine, deposited at the time of the first lumbar vertebra, the parameters do not interfere ventilometric, blood gas and cardiovascular diseases. And the dose of 6 mg/Kg determines the better analgesia of 4 mg/Kg
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Silva, Bruno Monteiro da. "Avaliação cardiorrespiratória e analgésica da ropivacaína isolada e associada ao fentanil ou ao tramadol, administrados pela via peridural em cães /." Araçatuba : [s.n.], 2007. http://hdl.handle.net/11449/92199.

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Orientador: Valéria Nobre Leal de Souza Oliva
Banca: Paulo Sérgio Patto dos Santos
Banca: Carmen Esther Grumadas Machado
Resumo: A anestesia peridural é amplamente difundida no meio veterinário, utilizando-se o anestésico local isolado ou associado aos opióides, capazes de promover aumento do efeito analgésico. A ropivacaína é um fármaco relativamente novo, ainda pouco utilizado em Veterinária. O fentanil é um opióide agonista e o tramadol é um opióide de ação mista. Neste experimento, oito cães foram tranqüilizados com acepromazina, submetidos à peridural com um dos protocolos a seguir: GR (ropivacaína), GRF (ropivacaína + fentanil), GRT (ropivacaína + tramadol), em volume total de 0,25 mL/kg. Durante o procedimento foram avaliados e comparados os seguintes parâmetros vitais (FC, f, temperatura retal, pressão arterial, e gasometria do sangue arterial), os bloqueios sensitivo e motor (latência e duração de ação), o grau de sedação, e a ocorrência de possíveis efeitos indesejáveis advindos da administração de ropivacaína isolada ou em associação. A diminuição mais intensa na FC ocorreu nos grupos GRF e GRT, e ocorreu hipotermia significativa nos animais do GRF. Todos os grupos apresentaram sedação, sendo severa nos grupos GRF e GRT. De maneira geral, o período de recuperação foi mais curto nos animais do grupo GRT do que nos demais. O GRT também foi o que apresentou bloqueio mais cranial. Foram observadas bradicardia, hipotermia e síndrome de Shiff- Sherrington no período trans-anestésico em animais de todos os grupos. Decorridas 24 horas de período pós-anestésico, não foram evidenciados efeitos indesejáveis, em nenhum dos grupos. GRF foi o grupo com maior duração de anestesia e analgesia, GRT apresentou a menor duração de anestesia com analgesia intermediária, e GR apresentou duração intermediária, com menor analgesia.
Abstract: Peridural anesthesia is broadly applied in the Veterinary field, using the isolated local anesthetic or in combination with opiates capable to increase the analgesic effect. The ropivacaine is a relatively new drug, not much used in the Veterinary field yet. The fentanil is an agonist opiate and tramadol is a mixed action opiate. In this experiment, eight dogs were sedated with acepromazine and subjected to the epidural anesthesia with one of the following protocols: GR (ropivacaine), GRF (ropivacaine + fentanyl), GRT (ropivacaine + tramadol), in 0,25mL/Kg of total volume. During the procedure, following vital signs were evaluated and compared (heart rate, respiratory rate, rectal temperature, blood pressure and gasometry of arterial blood), the sensory and motor blockade (latency and length of action), level of sedation and the occurrence of possible side effects due to administration of ropivacaine individually or in combination with other drugs. The highest decrease in the heart rate occurred in the following GRF and GRT and also significant hypothermia in animals of GRF. All groups presented sedation, even severe in the period of recovering was shorter in the animals belonging to GRT than in others. The GRT was also the one that presented the most cranial block. Bradycardia, hypothermia and Shiff- Sherrington syndrom were observed in the transanesthetic period in animals belonging to all of the groups. Twenty-four hours after the postanesthetic period, no side effects were observed, in none of the groups. The GRF was the one with higher length of anesthesia and analgesia, GRT presented the length of anesthesia with intermediate analgesia and, GR group presented intermediate length, with lower analgesia.
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Books on the topic "Epidural":

1

Chrubasik, Joachim. Postoperative epidural opioids. Berlin: Springer, 1993.

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Chrubasik, Joachim, Sigrun Chrubasik, and Laurence Mather. Postoperative Epidural Opioids. Berlin, Heidelberg: Springer Berlin Heidelberg, 1993. http://dx.doi.org/10.1007/978-3-642-78320-3.

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Capogna, Giorgio, ed. Epidural Labor Analgesia. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-13890-9.

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Wong, Cynthia A. Spinal and epidural anesthesia. New York: McGraw Hill Medical, 2007.

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Shah, Janti L. Factors affecting the epidural pressure. Birmingham: University of Birmingham, 1996.

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Capogna, Giorgio. Epidural Technique In Obstetric Anesthesia. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-45332-9.

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Middleton, Carolyn. Epidural Analgesia in Acute Pain Management. New York: John Wiley & Sons, Ltd., 2006.

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Covino, Benjamin G. Handbook of epidural anaesthesia and analgesia. Orlando: Grune and Stratton, 1985.

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Covino, Benjamin G. Handbook of epidural anaesthesia and analgesia. Orlando: Grune & Stratton, 1985.

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Shin, Jin Woo. Spinal Epidural Balloon Decompression and Adhesiolysis. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-15-7265-4.

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Book chapters on the topic "Epidural":

1

Dascanio, John J. "Epidural." In Equine Reproductive Procedures, 285–86. Hoboken, NJ, USA: John Wiley & Sons, Inc, 2014. http://dx.doi.org/10.1002/9781118904398.ch85.

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Wasson, Cassandra, Albert Kelly, David Ninan, and Quy Tran. "Epidural, Caudal, Spinal, Combined Spinal/Epidural." In Absolute Obstetric Anesthesia Review, 53–59. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-96980-0_21.

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Cooley, Laura A., Daniel G. Bausch, Marija Stojkovic, Waldemar Hosch, Thomas Junghanss, Marija Stojkovic, Waldemar Hosch, et al. "Epidural Hematoma." In Encyclopedia of Intensive Care Medicine, 877–81. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-00418-6_408.

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Champion, Howard R., Nova L. Panebianco, Jan J. De Waele, Lewis J. Kaplan, Manu L. N. G. Malbrain, Annie L. Slaughter, Walter L. Biffl, et al. "Abscess, Epidural." In Encyclopedia of Intensive Care Medicine, 30–31. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-00418-6_876.

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Gerasimenko, Yury, and Victor Reggie Edgerton. "Epidural Stimulation." In Encyclopedia of Computational Neuroscience, 1113–15. New York, NY: Springer New York, 2015. http://dx.doi.org/10.1007/978-1-4614-6675-8_591.

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Rush, Beth. "Epidural Hematoma." In Encyclopedia of Clinical Neuropsychology, 1315–16. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-57111-9_240.

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Eltorai, Ibrahim M. "Epidural Varix." In Rare Diseases and Syndromes of the Spinal Cord, 469–73. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-45147-3_137.

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Lam, Sandi, and Tien T. Nguyen. "Epidural Abscess." In International Neurology, 248–49. Oxford, UK: Wiley-Blackwell, 2010. http://dx.doi.org/10.1002/9781444317008.ch68.

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Bennett, Michelle, and Sharon Douglass. "Epidural Analgesia." In Care Planning in Children and Young People's Nursing, 116–22. West Sussex, UK: John Wiley & Sons, Ltd,., 2013. http://dx.doi.org/10.1002/9781118785324.ch13.

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Rush, Beth. "Epidural Hematoma." In Encyclopedia of Clinical Neuropsychology, 1. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-56782-2_240-2.

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Conference papers on the topic "Epidural":

1

Cavanagh, Daniel P., Asena Abay, Jessica M. Brito, Jasmine R. Joyner, Jordyn N. Nally, and Xianren Wu. "A Novel Epidural Catheter Fixation Device." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3490.

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Epidurals are a method of long-term pain relief administered by injecting and continuously delivering an anesthetic via catheter in the spine. This method of pain relief is often used for patients in the Obstetrics/Gynecology unit as well as those in pre- and post-operational care. For almost 2 million singleton vaginal deliveries across 27 states in 2008 (representing 65% of all US singleton vaginal births in 2008), 61% of patients received some form of an epidural or spinal injection [1]. Additionally, this number has been increasing. For the 18 states for which 2006 and 2008 data are available, the average of the state-level increases in epidural/spinal injections is approximately 4.2% revealing an overall increase in these injections. Just between 2000 and 2010, the use of epidural injections increased by 160% [2]. Commonly, epidural catheters are inserted into the patient’s back in the appropriate location and then secured to the body with an adhesive medical dressing. Movement and subsequent dislocation of the catheter beneath the adhesive medical dressing can result in inefficient anesthetic delivery, increased patient discomfort, and repeated administration of the epidural. Secondary migration of epidural catheters is a problem responsible for failure in approximately 6.8% of epidurals administered [3]. Requiring an anesthesiologist to repeat the procedure is also an increased cost. A solution to secondary migration of epidural catheters would ensure effective delivery of the anesthetic to the patient, reduce the need for a repeated procedure, and prevent unwanted additional healthcare expenses.
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Nielsen, T. H., H. K. Nielsen, S. E. Husted, S. L. Hansen, and K. H. Olsen. "PLATELET FUNCTION AND ENDOCRINE STRESS RESPONSE DURING BUPIVACAINE EPIDURAL ANALGESIA. THE EFFECT OF MORPHINE ADDITION." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644887.

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Platelet aggregation plays a central role in thromboembolism. Epidural analgesia can diminish the formation of deep venous thrombosis. In a randomized study twenty patients admitted to transartliroscopic meniscectomy were allocated to epidural analgesia with or without morphine epidurally. S-cortisol, s-thromboxane -B2(s-T2 B2) and platelet aggregation were measured before premedication, when epidural block extended from S3to T5, just before skin closure and exsufflation of tne thigh tourniquet, and the last sample was taken ten min after exsufflation. Aggregability was measured in platelet-rich plasma and expressed as the treshold concentration of collagen. Cortisol and T Bp were measured by RIA.S-cortisol decreased duringxanalgesia in the morphine group (p<o.o5), and during operation in both groups (p<o.o5) being significant lower in the morphine group (p<o.o5).S-TxB2 decreased significantly in the morphine group during analgesia, but there was no significant difference in s-TxB2 between the two groups. Treshold concentration of Collagen for aggregation of platelets showed an insignificant increase for both groups during analgesia, but did not differ between the two groups. Removal of the tourniquet did not influence any of the measurements. It is concluded that additionof morphine to bupivaca- ine epidural analgesia further decrease activity of the adrenocortical system, and the combined regime seems to inhibit platelet function in the same manner as monotherapy with local anaesthetics.
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Ferreira, L., D. Leite, C. Pinho, and S. Fonseca. "B215 Epidural hematoma after failed epidural catheter placement: case report." In ESRA Abstracts, 39th Annual ESRA Congress, 22–25 June 2022. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/rapm-2022-esra.290.

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4

Coşarcan, SK, AT Doğan, D. Akbay, and Ö. Erçelen. "24 Anterior cervical epidural hematoma after combined spinal epidural anesthesia: a case report." In ESRA 2021 Virtual Congress, 8–9–10 September 2021. BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/rapm-2021-esra.24.

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5

Allert, R., L. Jennewein, N. Bock, D. Brüggmann, and F. Louwen. "Perinatal outcomes of intended vaginal breech births with epidural versus non-epidural analgesia." In Kongressabstracts zur Tagung 2020 der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). © 2020. Thieme. All rights reserved., 2020. http://dx.doi.org/10.1055/s-0040-1717896.

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Vaughan, Neil, Venketesh N. Dubey, Michael Y. K. Wee, and Richard Isaacs. "Virtual Reality Based Enhanced Visualization of Epidural Insertion." In ASME 2012 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/detc2012-70951.

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This paper outlines an approach to create stereoscopic 3D computer graphics for visualization of epidural insertions. The graphics are built from several 3D vertex models of the anatomical structures including the vertebrae, tissue layers and the skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum and epidural space. The 3D models are wrapped with full color textures and vertex edges are rounded. The objects are stored in object files and are rendered as 3D by a custom OpenGL application. Graphics drivers calculate the angles and offset for the two separate stereo images and render both in 3D. The stereoscopic images are viewed through a visor containing two OLED micro-displays in stereo using the page-flipped method. The completed stereo simulation allows depth to be perceived so that the operator can judge depth of the needle tip in relation to tissue layers and bones, which aids to the location of the epidural space. Applying stereoscopic vision to epidural simulators will help the operator to visualize the depths required for correct needle placement in the epidural space.
7

Kao, Meng-Chun, Wen-Chuan Kuo, and Chien-Kun Ting. "The epidural needle guidance with an intelligent and automatic identification system for epidural anesthesia." In Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XVI, edited by Tuan Vo-Dinh, Anita Mahadevan-Jansen, and Warren S. Grundfest. SPIE, 2018. http://dx.doi.org/10.1117/12.2289750.

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Vaughan, Neil, and Venketesh N. Dubey. "Interpreting Ultrasound Images for Accurate Epidural Needle Insertion." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3494.

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This work presents development and testing of image processing algorithms for the automatic detection of landmarks within ultrasound images. The aim was to automate ultrasound analysis, for use during the process of epidural needle insertion. For epidural insertion, ultrasound is increasingly used to guide the needle into the epidural space. Ultrasound can improve the safety of epidural and was recommended by the 2008 NICE guidelines (National Institute for Health and Care Excellence). Without using ultrasound, there is no way for the anaesthetist to observe the location of the needle within the ligaments requiring the use of their personal judgment which may lead to injury. If the needle stops short of the epidural space, the anaesthetic is ineffective. If the needle proceeds too deep, it can cause injuries ranging from headache, to permanent nerve damage or death. Ultrasound of the spine is particularly difficult, because the complex bony structures surrounding the spine limit the ultrasound beam acoustic windows [1]. Additionally, the important structures for epidural that need to be observed are located deeper than other conventional procedures such as peripheral nerve block. This is why a low frequency, curved probe (2–5 MHz) is used, which penetrates deeper but decreases in resolution. The benefits of automating ultrasound are to enable real-time ultrasound analysis on the live video, mitigate human error, and ensure repeatability by avoiding variation in perception by different users. Previous ultrasound image processing for epidural research used speckle image enhancement with canny and gradient based methods for bone detection [2]. A clinical trial with 39 patients had success detecting the ligamentum flavum (LF) from ultrasound by algorithms in 87% of patients. Echogenic needles and catheters are now becoming available which are enhanced for extra ultrasound visibility. The Epimed UltraKath ULTRA-KATH™ [3] has a patented design to maximize visibility under ultrasound [4]. The Echogenic Tuohy Needle also includes imprints on the needle tip that reflects ultrasound, allowing for better visualization. Curved needles can also be detected in 2D ultrasound images [5].
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Vaughan, Neil, Venketesh N. Dubey, Michael Y. K. Wee, and Richard Isaacs. "In-Vivo Obstetric Pressure Measurements for Patient-Specific Epidural Simulator." In ASME 2014 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2014. http://dx.doi.org/10.1115/detc2014-35427.

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The aim of this study was to measure changing pressures during Tuohy epidural needle insertions for obstetric parturients of various BMI. This has identified correlations between BMI and epidural pressure. Also we investigated links between BMI and the thicknesses and depths of ligaments and epidural space as measured from MRI and ultrasound scans. To date there have been no studies relating epidural pressure and ligament thickness changes with varying Body Mass Indices (BMI). Further goals following measurement of pressure differences between various BMI patients, were to allow a patient-specific epidural simulator to be developed, which has not been achieved before. The trial has also assessed the suitability of our in-house developed wireless pressure measurement device for use in-vivo. Previously we conducted needle insertion trial with porcine for validation of the measurement system. Results showed that for each group average pressures during insertion decrease as BMI increases. Pressure measurements obtained from the patients were matched to tissue thickness measurements from MRI and ultrasound scans. The mean Loss of Resistance (LOR) pressure in each group reduces as BMI increases. Variation in the shape of the pressure graphs was noticed between two epiduralists performing the procedure, suggesting each anaesthetist may have a signature graph shape. This is a new finding which offers potential use in epidural training and assessment. It can be seen that insertions performed by the first epiduralist have a higher pressure range than insertions performed by second epiduralist.
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Vaughan, Neil, Venketesh N. Dubey, Michael Y. K. Wee, and Richard Isaacs. "Haptic Interface on Measured Data for Epidural Simulation." In ASME 2012 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/detc2012-70891.

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This paper presents a haptic device with 3D computer graphics as part of a high fidelity medical epidural simulator development program. The haptic device is used as an input to move the needle in 3D, and also to generate force feedback to the user during insertion. A needle insertion trial was conducted on a porcine cadaver to obtain force data. The data generated from this trial was used to recreate the feeling of epidural insertion in the simulator. The interaction forces have been approximated to the resultant force obtained during the trial representing the force generated by the haptic device. The haptic device is interfaced with the 3D graphics for visualization. As the haptic stylus is moved, the needle moves on the screen and the depth of the needle tip indicates which tissue layer is being penetrated. Different forces are generated by the haptic device for each tissue layer as the epidural needle is inserted. As the needle enters the epidural space, the force drops to indicate loss of resistance.

Reports on the topic "Epidural":

1

Ghobrial, George M., and James S. Harrop. Decompression and Spinal Fixation of Thoracic Epidural Tumor. Touch Surgery Simulations, April 2015. http://dx.doi.org/10.18556/touchsurgery/2015.s0063.

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Rowbotham, Professor David, Dr Jeremy Cashman, Dr David Counsell, Ms Felicia Cox, Dr Paulah Crawford, Dr John Goddard, Dr Simon Higgs, et al. Best practice in the management of epidural analgesia in the hospital setting. The Association of Anaesthetists of Great Britain and Ireland, November 2010. http://dx.doi.org/10.21466/g.bpitmoe.2010.

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Ran, Qiang, Yang Yu, Tong Li, and Xiaohong Fan. Epidural steroids following Percutaneous Endoscopic Interlaminar Discectomy : A protocol for systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2020. http://dx.doi.org/10.37766/inplasy2020.10.0085.

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Kwak, Sang Gyu, Yoo Jin Choo, Soyoung Kwak, and Min Cheol Chang. Efficacy of Transforaminal, Interlaminar, and Caudal Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Network Meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, August 2022. http://dx.doi.org/10.37766/inplasy2022.8.0091.

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Review question / Objective: Epidural injection (EI) has been used to manage lower back or radicular leg pain from herniation of lumbar disc (HLD). Three types of EI techniques, including transforaminal (TFEI) interlaminar (ILEI), and caudal epidural injections (CEI), are being applied. We aimed to evaluate the comparative effect of TFESI, ILEI, and CEI for reducing pain or improving function in patients with HLD. Condition being studied: For controlling inflammation by the HLD, various oral medications and procedures are used. Among these therapeutic methods, EI of the drugs is frequently used in clinical practice. Its positive HLD-induced pain reducing effect was reported in several previous studies. Three types of techniques, including TFEI, ILEI, and CEI, have been utilized in clinical practice. conflicting outcomes as to which technique is superior were reported in previous studies. So far, some meta-analysis studies for comparing the effects of different EI techniques on HLD were conducted. However, these previous studies conducted comparison between two procedures among TFEI, ILEI, and CEI. In the current study, using network meta-analysis, we synthesize and compare the effects of TFEI, ILEI, and CEI on pain from HLD, together.
5

Mullins, Mary F., and Tori E. Pearce. Two Different Epidural Analgesic Combinations: Morphine vs. Fentanyl/Bupivacaine or Fentanyl/Ropivacaine and Their Post Operative Effects. Fort Belvoir, VA: Defense Technical Information Center, September 2001. http://dx.doi.org/10.21236/ad1012418.

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Friedly, Janna, Zoya Bauer, Bryan Comstock, Judith Turner, Larry Kessler, Patrick Heagerty, Anjali Truitt, Danielle Lavallee, and Jeffrey Jarvik. Comparing the Effects of Two Types of Epidural Shots on Pain and Physical Ability in Older Adults with Lumbar Spinal Stenosis. Patient-Centered Outcomes Research Institute (PCORI)., April 2019. http://dx.doi.org/10.25302/4.2019.ce.12114469.

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Wen, Bei, Li Xu, and Yuguang Huang. Which minimally invasive therapy is most effective for the treatment of postherpetic neuralgia? An update meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0114.

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Review question / Objective: Which minimally invasive therapy is the best choice to alleviate pain for patients suffering from postherpetic neuralgia? Eligibility criteria: The eligibility criteria are interpreted under the PICOS (P, participants; I, interventions; C, comparison; O, outcomes; S, study design) framework. (1) P: ParticipantsInclusion criteria: Patients suffering from postherpetic neuralgia (the pain lasting more than 3 months after the onset of herpes zoster rash eruption or more than 1 month after the vesicles have healed).Exclusion criteria: 1. Patients who had other neuropathic pain; 2. Patients with acute or subacute zoster-related pain.(2) I: Interventions Inclusion criteria: Interventional treatments applied to PHN patients, as follows: 1) nerve block (including epidural block, intrathecal block, dorsal root ganglion block, intercostal nerve block, paravertebral block, erector spinae plane block);2) subcutaneous injection (including subcutaneous injection of normal saline, local anesthetics, corticosteroids, MeB12 as well as local infiltration);3) stellate ganglion block;4) subcutaneous botulinum toxin type A injection;5) pulsed radiofrequency with or without.
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Epidural anaesthesia helps return of bowel function after abdominal surgery. National Institute for Health Research, September 2016. http://dx.doi.org/10.3310/signal-000308.

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Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births. National Institute for Health Research, December 2017. http://dx.doi.org/10.3310/signal-000519.

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Delaying pushing in labour has no benefit for women with an epidural and/or spinal for pain relief. National Institute for Health Research, February 2019. http://dx.doi.org/10.3310/signal-000730.

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