Anesth Analg
Department of Anesthesiology, Rikshospitalet University Hospital, University of Oslo, N-0027 Oslo, Norway.
Published: June 2002
Unlabelled: We have shown that epinephrine markedly improves the analgesic effect of a thoracic epidural infusion of bupivacaine and fentanyl. Ropivacaine has an intrinsic vasoconstrictive effect, and epinephrine may therefore not have the same pharmacokinetic interaction in a ropivacaine-fentanyl infusion; but a possible spinal cord alpha(2)-agonist effect of epinephrine would give the same positive pharmacodynamic interaction with ropivacaine and fentanyl during epidural analgesia. In a prospective, randomized, crossover study, a thoracic epidural infusion of ropivacaine 1 mg/mL and fentanyl 2 microg/mL with or without epinephrine 2 microg/mL was given to 12 patients in a double-blinded manner after major thoracic or upper abdominal surgery. Main outcome measures were pain intensity at rest and when coughing, evaluated on a visual analog scale. Extent of sensory blockade was evaluated by determining dermatomal hypoesthesia to cold. Pain increased (P < 0.001) and hypoesthetic dermatomal segments decreased (P < 0.001) when epinephrine was omitted from the triple epidural infusion. After 3 h without epinephrine, pain intensity when coughing was unacceptable despite rescue analgesia. After restarting the triple epidural mixture with epinephrine, pain was again reduced to mild pain when coughing, and the sensory blockade was restored. The mixture with epinephrine caused less nausea and facilitated mobilization. We conclude that epinephrine improves the pain relief and reduces the side effects of a thoracic epidural infusion of ropivacaine and fentanyl after major thoracic or upper abdominal surgery.
Implications: Epidural epinephrine markedly improves the pain relief and sensory blockade of a small-dose thoracic epidural infusion of ropivacaine and fentanyl. Nausea was reduced, and mobilization of the patients was facilitated.
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http://dx.doi.org/10.1097/00000539-200206000-00044 | DOI Listing |
Cir Esp (Engl Ed)
January 2025
Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain. Electronic address:
Introduction: Extended thromboprophylaxis with low-molecular-weight heparin (LMWH) for 28 days is recommended in patients undergoing major abdominal or pelvic cancer surgery, but the evidence for thoracic cancer surgery is weak. We aimed to evaluate the use of pharmacological thromboprophylaxis and incidence of venous thromboembolism (VTE) in adult patients undergoing lung cancer surgery in daily clinical practice.
Methods: Retrospective evaluation of a cohort of consecutive adult patients who had undergone lung cancer surgery.
Br J Anaesth
January 2025
Optomize Ltd, Glasgow, UK.
J Cardiothorac Vasc Anesth
January 2025
Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address:
Minimally invasive cardiac surgery (MICS) often leads to severe postoperative pain. At present, multimodal analgesia schemes for MICS have attracted much attention, and the application of various chest wall analgesia techniques is becoming increasingly widespread. However, research on anesthesia techniques for postoperative pain management in MICS remains relatively limited at present.
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December 2024
Anesthesiology, Rhode Island Hospital, Brown University, Providence, USA.
Acute pain service was consulted for acute pain management in a 40-year-old male who had sustained multiple bilateral rib fractures following a fall injury. In addition to the rib fractures, the patient had also experienced injuries to his lungs and spinal column, both of which required surgeries. Considering the significant nature of pain due to his rib fractures, a multimodal pain management approach that included both pharmacological and non-pharmacological strategies was utilized.
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December 2024
Anesthesiology, Centro Hospitalar Universitário de São João, Porto, PRT.
Background Lung resection is a complex surgical procedure performed in children to address various pulmonary conditions. The success of this surgical intervention in these patients lies in a multidisciplinary approach, with anesthetic management playing a critical role in ensuring the safety and efficacy of the procedure. Methods After approval by the local ethics committee, clinical data of 17 pediatric patients who underwent lung resection in our hospital from January 2012 to December 2022 were retrospectively analyzed.
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