Skip to main content

Epidural analgesia, gastrointestinal motitity and intestinal blood flow


--Thoracic (above the T12 dermatome) epidural local anesthetics (e.g. bupivacaine) can have clinically significant effects to decrease the duration of ileus after abdominal surgery.

--The most optimal post-op analgesia , in terms of minimizing post-op ileus, appears to be a combination of low-dose epidural bupivacaine plus morphine.

--In order for this combination to be effective, it should be delivered via a thoracic epidural catheter, ideally with the tip of the catheter as close as possible to the dermatome in the middle of the surgical incision. (e.g. T10 for an upper abdominal incision)


Safeguarding intestinal perfusion is a critical issue in the maintenance of intestinal function and integrity of the mucosal barrier.
The effect of epidural bupivacaine (5mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in patients during large bowel resection.
In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41%.
(K. Johansson British Journal of Surgery 2005 Vol 75 Issue 1, P 73-76)


Epidural analgesia increased 7-day surival from 33% to 73% (p<0.05)
Thoracic epidural analgesia attenuated systemic response and improved survival in severe acute pancreatitis.
These effects might be explained by improved mucosal perfusion.
(Freise Hendrik Anesthesiology 2006; 105(2):354-9.)


After oesophagectomy, continuous infusion bupivacaine 10 ml/hr, increased the anastomotic mucosal blood flow.
(Michelet P et. al acta anesthesiol. Scan. 2007 51:587-94)


Thoracic epidural analgesia provides a significant benefit in terms of
*less analgesic consumption
*better post-op pain relief
*and faster recovery of gastrointestinal function
in patients undergoing laparoscopic colorectal resection
(ZINGG Urs 2009, vol 23, n2 pp. 276-282)
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more