RESUMO
BACKGROUND: Open liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection. METHODS: A retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects. RESULTS: A total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). CONCLUSIONS: Epidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance. TRIAL REGISTRATION: The study was registered in the Clinical Trials Registry at www. CLINICALTRIALS: gov/ , NCT number: NCT06301932.
Assuntos
Analgesia Epidural , Analgésicos Opioides , Hepatectomia , Morfina , Dor Pós-Operatória , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Analgesia Epidural/métodos , Analgésicos Opioides/administração & dosagem , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Morfina/administração & dosagem , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Pontuação de Propensão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Studies have shown that the ideal dose of epidural dexmedetomidine is 0.4â µgâ mL-1 for epidural labor analgesia. However, the appropriate dose of ropivacaine when combined with 0.4â µgâ mL-1 of dexmedetomidine for epidural labor analgesia is still unknown. Therefore, we aimed to determine the dose-response of ropivacaine when using 0.4â µgâ mL-1 of dexmedetomidine as epidural adjuvant for labor analgesia. METHODS: One hundred of nulliparous singleton pregnant patients were randomized allocated into 1 of 5 groups with epidural ropivacaine concentration of 0.05%, 0.0625%, 0.075%, 0.0875%, and 0.1%. Labor analgesia was initialed with 12 mL of the mixed study solution. Effective analgesia was defined as a visual analogue scale <10 mm 30 minutes after the initial epidural bolus. The EC50 and EC95 for epidural ropivacaine was calculated by probit regression. RESULTS: Ninety-three of parturients were involved into the final analysis. Totals of 63.2% (12/19), 73.7% (14/19), 88.9% (16/18), 94.7% (18/19), and 100% (18/18) of parturients in group 0.05, 0.0625, 0.075, 0.0875, and 0.1 received effective epidural labor analgesia. The calculated EC50 and EC95 of epidural ropivacaine were 0.046% (95% CI 0.028-0.054%) and 0.086% (95% CI 0.074-0.137%), respectively. CONCLUSIONS: Under the condition of the study, a bolus of 12 mL ropivacaine 0.086% and dexmedetomidine 0.4â µgâ mL-1 could afford 95% of nulliparous singleton pregnant patients without suffering labor pain after a test dose of lidocaine 45 mg.
Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais , Dexmedetomidina , Relação Dose-Resposta a Droga , Ropivacaina , Humanos , Feminino , Ropivacaina/administração & dosagem , Gravidez , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Adulto , Analgesia Epidural/métodos , Anestésicos Locais/administração & dosagem , Estudos Prospectivos , Analgesia Obstétrica/métodos , Analgésicos não Narcóticos/administração & dosagem , Medição da Dor , Dor do Parto/tratamento farmacológico , Adulto JovemRESUMO
Labor epidural analgesia (LEA) is associated with increased maternal body temperature; however, the responsible mechanism is unknown. Recent studies suggest that changes in EA affect the incidence of fever and that epidural sufentanil supplementation enhances analgesia and reduces the amount of local anesthetic. The aim of this study was to evaluate the effect of different concentrations of sufentanil combined with ropivacaine on intrapartum fever during delivery. We performed a retrospective study comparing maternal fever rates in patients receiving labor analgesia between December 2018 and January 2019. Each patient receiving different concentrations of sufentanil in their EA received either proposal H (0.08% ropivacaineâ +â 0.4 µg/mL sufentanil) or proposal L (0.08% ropivacaineâ +â 0.2 µg/mL sufentanil), with the same nulliparous status. The primary outcome of this study was the incidence of intrapartum maternal fever, which was defined as any temperatureâ ≥â 38°C during labor using Fisher exact test. Secondary outcome measures included visual analog scale (VAS) pain scores, birth events, and neonatal outcomes. We observed a perinatal fever incidence rate of 11.7% in the group receiving proposal L, while the incidence rate was 19.8% in the group receiving proposal H (Pâ =â .001). Five hours after administration, the average body temperature of the puerpera decreased significantly in the proposal L group compared with proposal H group. In addition, treatment with 0.2 µg/mL sufentanil provided satisfactory pain relief during labor, shortened the first stage of labor and total labor time, reduced oxytocin use, and had no significant adverse effects on neonatal outcomes. EA may increase the risk of intrapartum epidural-associated fever. Compared with the 0.4 µg/mL sufentanil group, the 0.2 µg/mL sufentanil group can provide better analgesia and improve maternal fever. These retrospective results highlighted the importance of prospective and mechanistic studies of maternal fever associated with intraspinal analgesia.
Assuntos
Analgesia Epidural , Anestésicos Locais , Febre , Ropivacaina , Sufentanil , Humanos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico , Feminino , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Gravidez , Estudos Retrospectivos , Adulto , Febre/epidemiologia , Febre/prevenção & controle , Analgesia Epidural/métodos , Analgesia Epidural/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efeitos adversos , Trabalho de Parto/efeitos dos fármacos , Medição da Dor , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , IncidênciaRESUMO
BACKGROUND: Labour pain is associated with detrimental maternal and foetal physical and psychological effects. Labour analgesia is a basic right for all women and labour epidural analgesia has been accepted as the gold standard for providing such, with reported improvement in patient satisfaction. In South Africa, studies have shown that labour epidural rates are low. At an academic hospital in Johannesburg, a 24-h labour epidural service combined with an awareness campaign and educational programme (LEAP) was initiated with the aim of improving labour epidural rates. Results showed a short-lived uptake with a subsequent decline. OBJECTIVES: This study explored the experiences of labour ward nursing staff regarding the labour epidural service at this academic hospital including perceived limitations and possible recommendations regarding improving service provision. METHOD: A qualitative, descriptive and exploratory study was conducted. Purposive sampling was used with semistructured, audio-recorded individual interviews, thematic analysis was performed using Braun and Clarke's six-phase approach. RESULTS: The key theme is required education and supervision of epidural insertion (see page 3), management of childbirth and challenges related to epidural service provision. CONCLUSION: A positive sentiment was expressed by the participants; however, deficiencies in the service such as shortages of experienced personnel, work constraints and insufficient training may be affecting service sustainability. Further studies are recommended to form guidance towards the development and implementation of interventions to improve service delivery.Contribution: Provision of continual training and increased staffing of healthcare personnel will help improve the sustainability of the labour epidural service.
Assuntos
Analgesia Epidural , Pesquisa Qualitativa , Humanos , África do Sul , Feminino , Gravidez , Analgesia Epidural/estatística & dados numéricos , Analgesia Epidural/métodos , Analgesia Epidural/psicologia , Adulto , Percepção , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Atitude do Pessoal de Saúde , Entrevistas como Assunto/métodos , Dor do Parto/psicologiaRESUMO
INTRODUCTION: Anaesthetic choices in cancer surgery, including the use of epidural analgesia, may affect immune function during the perioperative period and might play an important role in subsequent cancer spread and recurrence. METHODS: This was a prospective, randomised, controlled, double-blinded, single-centre study allocating patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy to post-operative pain management using either thoracic epidural analgesia or oral morphine. We compared pre-, per-, and post-operative plasma levels of interleukin (IL)-6, IL-10, IL-12, and interferon (IFN)-γ using regression analysis, and conducted a two-year survival follow-up. RESULTS: A total of 66 patients were randomised. Fifty-six received the allocated treatment and were analysed. None of the investigated cytokines exhibited significant between-group differences in plasma concentrations when adjusted for the chosen covariates (p ≥ 0.204). A two-year follow-up showed no difference in survival between the two groups (p = 0.5). CONCLUSION: Our study found no differences in the impact on the innate, non-specific immune system related to epidural analgesia for pain management in VATS. FUNDING: The Danish Cancer Society (R150-A10139). Oberstinde Kirsten Jensa la Cours Mindelegat (JSP-25076). University of Southern Denmark, Region of Southern Denmark and Department of Anaesthesia and Intensive Care, Odense University Hospital. TRIAL REGISTRATION: NCT02359175 (ClinicalTrials.gov).
Assuntos
Analgesia Epidural , Analgésicos Opioides , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Humanos , Analgesia Epidural/métodos , Masculino , Feminino , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Método Duplo-Cego , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Administração Oral , Morfina/administração & dosagem , Neoplasias Pulmonares/cirurgia , Interleucina-10/sangue , Interleucina-6/sangue , Interleucina-12/sangueRESUMO
Importance: Epidural analgesia is used by approximately 70% of birthing persons in the US to alleviate labor pain and is a common cause of elevated temperature in the birthing parent during labor, which, in turn, is associated with adverse neonatal outcomes such as hypoxic-ischemic encephalopathy (HIE). Objective: To determine whether epidural analgesia is associated with increased risk of HIE after adjusting for the birthing person's maximal temperature before epidural placement and for the propensity to get an epidural. Design, Setting, and Participants: This retrospective, population-based cohort study was conducted at 15 Kaiser Permanente Northern California hospitals. Participants included singleton neonates born at 35 weeks' or later gestational age between 2012 and 2019. Elective cesarean deliveries and deliveries within 2 hours of hospital admission were excluded. Data analysis was performed from November 2022 to June 2024. Exposure: The primary exposure was epidural analgesia during labor. Main Outcomes and Measures: The primary outcome was HIE, defined as the presence of both neonatal acidosis (ie, pH <7 or base deficit ≥10) and encephalopathy. The presence and timing of epidural analgesia and demographic, pregnancy, and labor characteristics were extracted from electronic medical records. A propensity score for receiving epidural analgesia was created including demographic variables and comorbidities predating epidural placement. Logistic regression was used to evaluate the association between epidural analgesia and HIE, adjusting for maximal birthing parent's temperature before epidural placement and the propensity for receiving an epidural. Results: Among 233â¯056 infants born at 35 weeks' or later gestational age by vaginal or unplanned cesarean delivery after at least 2 hours of in-hospital labor, 177â¯603 (76%) were exposed to epidural analgesia and 439 (0.19%) had HIE. On unadjusted analysis, epidural analgesia was associated with an increased risk of maximal temperature greater than 38 °C during labor (risk ratio [RR], 8.58; 95% CI, 8.06-9.14). Each degree increase in maximal temperature during labor was associated with nearly triple the odds of HIE (odds ratio [OR], 2.82; 95% CI, 2.51-3.17). However, there was no significant association between epidural analgesia and the risk of HIE either on crude (RR, 1.21; 95% CI, 0.96-1.53) or adjusted (adjusted OR, 0.93; 95% CI, 0.73-1.17) analyses. Conclusions and Relevance: In this cohort study including more than 230â¯000 parent-infant dyads, epidural analgesia was associated with increased maximal temperature during labor, a known risk factor for HIE. However, epidural analgesia was not associated with increased odds of HIE.
Assuntos
Analgesia Epidural , Hipóxia-Isquemia Encefálica , Humanos , Analgesia Epidural/efeitos adversos , Analgesia Epidural/estatística & dados numéricos , Feminino , Hipóxia-Isquemia Encefálica/epidemiologia , Gravidez , Recém-Nascido , Estudos Retrospectivos , Adulto , California/epidemiologia , Masculino , Trabalho de Parto/fisiologia , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/estatística & dados numéricos , Analgesia Obstétrica/métodos , Estudos de CoortesRESUMO
Shortening analgesic onset has been researched and it has been documented that prewarming epidural medications to body temperature (37°C) prior to administration increases medication efficacy. Our double-blind randomized controlled trial was designed to investigate if a lower degree of prewarming in providers' pockets could achieve similar results without the need of a bedside incubator. A total of 136 parturients were randomized into either the pocket-warmed group or the room temperature group to receive 10 mL of 0.125% bupivacaine with 2 µg/mL fentanyl epidural bolus at either the 27.8 ±1.7°C or 22.1 ±1.0°C temperatures, respectively. Primary outcome, time to analgesic onset (verbal rating scale pain score ≤ 3) was recorded in 0-, 5-, 10-, 15-, 20-, 30-, and 60-minutes intervals. It was observed that the pocket-warming group (n = 64) and room temperature group (n = 72) had no significant difference of analgesic onset time (median 8 vs. 6.2 minutes; p = 0.322). The incidence of adverse events such as hypotension, fever (≥ 38°C), nausea, vomiting, and number of top-off epidural boluses, as well as patient satisfaction rates and mode of delivery, were not significantly different between the groups as well. Further research is warranted to confirm these findings and explore the impact of different temperatures on analgesic onset time as well as the logistical issues associated with their clinical implementations.
Assuntos
Analgesia Epidural , Bupivacaína , Fentanila , Humanos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Analgesia Epidural/métodos , Bupivacaína/administração & dosagem , Adulto , Método Duplo-Cego , Gravidez , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efeitos adversos , Anestésicos Locais/administração & dosagem , Adulto JovemRESUMO
BACKGROUND: It was reported that either shorter programmed intermittent epidural bolus (PIEB) intervals or high-speed bolus can produce more extensive epidural spread. We hypothesized that a combination of shortened time interval and increased speed of epidural bolus might further improve analgesic effect and therefore reduce the hourly volume for epidural labour analgesia. METHODS: This double-blind dose-finding study used a biased coin up-and-down sequential allocation method to determine the 90% effective bolus volume of ropivacaine combined with sufentanil while using the push pump at a rate of 400 mL/hr and interval of 30 min to provide effective analgesia without breakthrough pain. We used 0.1% ropivacaine with 0.4 µg/mL sufentanil, with bolus volumes ranging from 3 to 6 mL. The first patient was assigned a volume of 3 mL, and the remaining volumes were assigned according to the biased coin-up-and-down method. RESULTS: The estimated 90% effective volume (EV90) of ropivacaine combined with sufentanil for epidural labour analgesia at a time interval of 30 min was 4.88 mL (95% confidence interval 4.83-5.38). CONCLUSIONS: The optimum bolus volume of ropivacaine with sufentanil while using push pump at a time interval of 30 min is approximately 5 mL. It could probably further reduce the hourly bolus volume for epidural labour analgesia.
Assuntos
Amidas , Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais , Ropivacaina , Sufentanil , Humanos , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem , Método Duplo-Cego , Feminino , Analgesia Epidural/métodos , Gravidez , Adulto , Anestésicos Locais/administração & dosagem , Analgesia Obstétrica/métodos , Amidas/administração & dosagem , Analgésicos Opioides/administração & dosagem , Relação Dose-Resposta a Droga , Fatores de Tempo , Adulto JovemRESUMO
Background and Objectives: Surgical wound analgesia has been analyzed in many studies, but few have focused on its relationship with inflammatory markers. As such, we aimed to determine the influence of analgesic surgical wound infiltration in open colorectal surgery on the seric levels of pro- and anti-inflammatory markers and the associated efficacy in postoperative pain control. Materials and Methods: Forty patients who underwent open colorectal surgery were prospectively randomized: group 0, epidural analgesia; group 1, intravenous analgesia (control), group 2, preincision and prelaparoraphy infiltration; and, group 3, prelaparoraphy infiltration. Wound infiltration was performed with ropivacaine. We analyzed the levels of IL-6 and IL-10 cytokines before and 6 h after surgery and their correlation with pain scores. Results: The postoperative Il-6 levels were significantly lower in group 0 than in the control (p = 0.041). The postoperative Il-10 levels were significantly higher in group 3 (p = 0.029) than in the control. Six hours after the operation, the pain scores were significantly lower in all groups than in the control (p = 0.005, p = 0.022, and p = 0.017 for groups 0, 2, and 3, respectively). Pain scores were significantly correlated with Il-10 levels in group 2 (p = 0.047); in group 3, IL-10 levels directly correlated with those of Il-6 (p = 0.026). Conclusions: The analgetic effect of preincisional and prelaparoraphy analgetic infiltration was efficient. The analgetic infiltration of the surgical wound prior to closure stimulates both the inflammatory activator and regulator interleukins.
Assuntos
Dor Pós-Operatória , Humanos , Dor Pós-Operatória/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Projetos Piloto , Idoso , Interleucina-10/sangue , Interleucina-10/análise , Ropivacaina/uso terapêutico , Ropivacaina/administração & dosagem , Estudos Prospectivos , Citocinas/sangue , Interleucina-6/sangue , Interleucina-6/análise , Cirurgia Colorretal/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Medição da Dor/métodos , Adulto , Ferida Cirúrgica/tratamento farmacológico , Ferida Cirúrgica/complicações , Analgésicos/uso terapêutico , Analgesia Epidural/métodosRESUMO
STUDY OBJECTIVE: Nitrous oxide affects memory and recall. We aimed to determine if using nitrous oxide during labor affected patients' ability to learn and recall the risks and benefits of neuraxial analgesia. DESIGN: Single-center, prospective cohort study. SETTING: Labor and delivery unit in a large academic medical center. PATIENTS: Nulliparous patients with spontaneous or planned induction of labor. INTERVENTIONS: Parturients chose whether to use nitrous oxide during labor. At the discussion for epidural consent, 4 risks were described: headache, infection, nerve damage, bleeding. MEASUREMENTS: Labor pain score, time from nitrous oxide discontinuation, and cervical dilation were documented at the discussion of epidural risks. Patients were assessed for unprompted recall and prompted recall of epidural risks on postpartum day 1 and unprompted recall at postpartum week 6. The number and proportion of patients who indicated each true risk (unprompted and prompted recall) or distractor (prompted recall only) were summarized by treatment group and results compared using Pearson χ2 tests. MAIN RESULTS: Of the 403 enrolled patients, 294 (73%) did not use nitrous oxide, and 109 (27%) did. The 2 groups were similar except women who used nitrous oxide were more likely to be cared for by midwives and had higher pain scores at their epidural request. Scores for unprompted or prompted recall of epidural risks were not different between women who received or did not receive nitrous oxide. All 4 risks were recalled unprompted by only 3% in the nitrous oxide group and by 6% in the group not receiving nitrous oxide (P = .18). CONCLUSIONS: The use of nitrous oxide for labor analgesia does not adversely influence a parturient's ability to recall the risks of epidural placement. Patients who receive nitrous oxide for labor analgesia should be considered eligible to provide consent for subsequent procedures.
Assuntos
Analgesia Epidural , Analgesia Obstétrica , Rememoração Mental , Óxido Nitroso , Humanos , Óxido Nitroso/efeitos adversos , Óxido Nitroso/administração & dosagem , Feminino , Gravidez , Estudos Prospectivos , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Rememoração Mental/efeitos dos fármacos , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Medição da Dor/estatística & dados numéricos , Trabalho de Parto/efeitos dos fármacos , Medição de RiscoRESUMO
OBJECTIVE: To determine which locoregional techniques are effective in managing post-operative pain in major open oncologic gynecologic surgery in terms of pain scores and opioid consumption when epidural analgesia is not a feasible option. METHODS: A systematic review of the literature, based on the Preferred Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, was conducted. The ROB-2 assessment was used to assess bias. The primary outcomes were opioid consumption and post-operative pain scores. Secondary outcomes included post-operative markers such as time to mobilization and bowel movement. RESULTS: A total of nine studies (n=714) were included in the analysis. Eight studies had a low risk of bias. Five different forms of locoregional analgesia were described. Eight studies compared with placebo and one study compared rectus sheath block with epidural analgesia. Three of the five studies investigating transversus abdominis plane (TAP) blocks showed an improvement in pain scores and opioid consumption when compared with the placebo group. One study investigating rectus sheath blocks and another investigating paravertebral blocks demonstrated significantly less opioid consumption and improved pain scores at certain time points. The studies investigating continuous wound infiltration and superior hypogastric plexus block found no significant effect. No adverse effects of locoregional anesthesia were found. CONCLUSION: Our study showed that TAP blocks, rectus sheath blocks, and paravertebral blocks may decrease opioid consumption and improve pain scores in patients undergoing open abdominal surgery for gynecologic cancer. Additionally, these techniques might serve as a viable alternative for patients with contraindications to epidural analgesia.
Assuntos
Neoplasias dos Genitais Femininos , Dor Pós-Operatória , Humanos , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Laparotomia/efeitos adversos , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Analgesia Epidural/métodosRESUMO
PURPOSE OF REVIEW: Heart and lung transplantation evolution marked significant milestones. Pioneering efforts of Dr Christiaan Barnard with the first successful heart transplant in 1967, followed by advancements in heart-lung and single-lung transplants by Drs Bruce Reitz, Norman Shumway, and Joel Cooper laid the groundwork for contemporary organ transplantation, offering hope for patients with end-stage heart and pulmonary diseases. RECENT FINDINGS: Pretransplant opioid use in heart transplant recipients is linked to higher mortality and opioid dependence posttransplant. Effective pain control is crucial to reduce opioid-related adverse effects and enhance recovery. However, research on specific pain management protocols for heart transplant recipients is limited. In lung transplantation effective pain management is crucial. Studies emphasize the benefits of multimodal strategies, including thoracic epidural analgesia and thoracic paravertebral blocks, to enhance recovery and reduce opioid use. Perioperative pain control challenges in lung transplantation are unique and necessitate careful consideration to prevent complications and improve outcomes. SUMMARY: This review emphasizes the importance of tailored pain management in heart and lung transplant recipients. It advocates for extended follow-up and alternative analgesics to minimize opioid dependency and enhance quality of life. Further high-quality research is needed to optimize postoperative analgesia and improve patient outcomes.
Assuntos
Analgésicos Opioides , Transplante de Coração , Transplante de Pulmão , Manejo da Dor , Dor Pós-Operatória , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/terapia , Manejo da Dor/métodos , Transplante de Pulmão/efeitos adversos , Transplante de Coração/efeitos adversos , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/etiologia , Bloqueio Nervoso/métodos , Bloqueio Nervoso/efeitos adversos , Qualidade de VidaRESUMO
BACKGROUND: Labor analgesic interventions, particularly the use of opioids and epidural anaesthesia, have raised concerns regarding their potential impact on postpartum urinary retention (PUR), necessitating a comprehensive investigation into their association with this clinical outcome. METHODS: This retrospective case-control study analysed clinical data from postpartum patients at our hospital from January 2023 to December 2023. Anaesthetic methods, including opioid and non-opioid drug usage, epidural analgesia and non-use of analgesia, were assessed. Logistic regression analysis was also performed to determine important associations with apparent PUR. RESULTS: This study included clinical data from 54 postpartum patients with PUR and 54 without urinary retention. A higher percentage of women with apparent PUR received opioids during labour compared with those without PUR (p = 0.033). Conversely, a lower percentage of women with apparent PUR received non-opioid analgesics compared with those without PUR (p = 0.026). In addition, a higher percentage of women with apparent PUR received epidural analgesia compared with those without PUR (p = 0.041). Logistic regression analysis demonstrated that opioid consumption during labour was significantly associated with apparent PUR (odds ratio (OR) = 2.469, p = 0.022). By contrast, non-opioid consumption during labour was inversely associated with apparent PUR (OR = 0.297, 95% CI = 0.123-0.681, p = 0.005). In addition, the use of epidural analgesia during labour showed a remarkable association with apparent PUR (OR = 2.857, 95% CI = 1.289-6.552, p = 0.011). CONCLUSIONS: Opioid use during labour and the use of epidural analgesia were identified as important risk factors for apparent PUR. These findings emphasise the need for a thoughtful and balanced approach to analgesic management during labour to minimise the risk of PUR in obstetric patients.
Assuntos
Analgesia Epidural , Analgesia Obstétrica , Analgésicos Opioides , Anestesia Epidural , Retenção Urinária , Humanos , Retenção Urinária/etiologia , Feminino , Analgésicos Opioides/administração & dosagem , Gravidez , Estudos Retrospectivos , Estudos de Casos e Controles , Adulto , Fatores de Risco , Transtornos Puerperais/etiologiaAssuntos
Analgesia Epidural , Analgésicos Opioides , Morfina , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Humanos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Analgesia Epidural/métodos , Morfina/administração & dosagem , Analgésicos Opioides/administração & dosagem , Administração Oral , Manejo da Dor/métodos , Feminino , Masculino , Pessoa de Meia-IdadeAssuntos
Analgesia Epidural , Analgésicos Opioides , Morfina , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Humanos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Analgesia Epidural/métodos , Morfina/administração & dosagem , Cirurgia Torácica Vídeoassistida/métodos , Analgésicos Opioides/administração & dosagem , Administração Oral , Feminino , Masculino , Resultado do Tratamento , Pessoa de Meia-Idade , Idoso , Medição da Dor/métodosAssuntos
Analgesia Epidural , Analgésicos Opioides , Morfina , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Humanos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Morfina/administração & dosagem , Analgesia Epidural/métodos , Analgésicos Opioides/administração & dosagem , Administração Oral , Manejo da Dor/métodosAssuntos
Analgesia Epidural , Períneo , Ultrassonografia de Intervenção , Cães , Animais , Fluoroscopia/veterinária , Ultrassonografia de Intervenção/veterinária , Períneo/cirurgia , Analgesia Epidural/veterinária , Analgesia Epidural/métodos , Doenças do Cão/cirurgia , Masculino , Cateterismo/veterinária , Cateterismo/métodos , Feminino , Dor Pós-Operatória/veterinária , Dor Pós-Operatória/prevenção & controleAssuntos
Analgésicos Opioides , Morfina , Gatos , Animais , Morfina/efeitos adversos , Morfina/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/administração & dosagem , Overdose de Drogas/veterinária , Analgesia Epidural/veterinária , Analgesia Epidural/efeitos adversos , Doenças do Gato/induzido quimicamente , Masculino , FemininoRESUMO
BACKGROUND: Effective postoperative pain management is essential for patient satisfaction and an uneventful postoperative course, particularly in body contouring procedures. Systemic analgesic regimens can be supported by regional procedures, such as the transverse abdominis plane (TAP) block, but these have a limited duration of action. In contrast, thoracic epidural analgesia offers the possibility of a longer-lasting, individualized regional anesthesia administered by a patient-controlled analgesia pump. OBJECTIVES: The aim of this study was to investigate the effects of a patient-controlled epidural analgesia to better classify the clinical value of this procedure in abdominoplasties. MATERIALS AND METHODS: This work reviewed the digital medical charts of patients who underwent selective abdominoplasty without combined surgical procedures between September 2018 and August 2022. Evaluated data comprise the postoperative analgesia regimen, including on-demand medication, mobilization time, inpatient length of stay, and clinical outcome. The patients were grouped by the presence of a thoracic epidural catheter. This catheter was placed before anesthetic induction and a saturation dose was preoperatively applied. Postoperative PCEA patients received a basal rate and could independently administer boluses. Basal rate was individually adjusted during daily additional pain visits. RESULTS: The study cohort included 112 patients. Significant differences in the demand for supportive nonepidural opiate medication were shown between the patient-controlled epidural analgesia (PCEA) group (n = 57) and the non-PCEA group (n = 55), depending on the time after surgery. PCEA patients demanded less medication during the early postoperative days (POD 0: PCEA 0.13 (±0.99) mg vs non-PCEA 2.59 (±4.55) mg, P = 0.001; POD 1: PCEA 0.79 mg (±3.06) vs non-PCEA 2.73 (±3.98) mg, P = 0.005), but they required more during the later postoperative phase (POD 3: PCEA 2.76 (±5.60) mg vs non-PCEA 0.61 (±2.01) mg, P = 0.008; POD 4: PCEA 1.64 (±3.82) mg vs non-PCEA 0.07 (±2.01) mg, P = 0.003). In addition, PCEA patients achieved full mobilization later (PCEA 2.67 (±0.82) days vs non-PCEA 1.78 (±1.09) days, P = 0.001) and were discharged later (PCEA 4.84 (±1.23) days vs non-PCEA 4.31 (±1.37) days, P = 0.005). CONCLUSION: Because the postoperative benefits of PCEA are limited to potent analgesia immediately after abdominoplasty, less cumbersome, time-limited regional anesthesia procedures (such as TAP block) appear not only adequate but also more effective.