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Titolo:
THORACIC VERSUS LUMBAR EPIDURAL ANESTHESIAS EFFECT ON PAIN CONTROL AND ILEUS RESOLUTION AFTER RESTORATIVE PROCTOCOLECTOMY
Autore:
SCOTT AM; STARLING JR; RUSCHER AE; DELESSIO ST; HARMS BA;
Indirizzi:
UNIV WISCONSIN HOSP & CLIN,DEPT SURG,H4756 CSC MADISON WI 53792 UNIV WISCONSIN HOSP & CLIN,DEPT SURG MADISON WI 53792 UNIV WISCONSIN HOSP & CLIN,DEPT ANESTHESIOL MADISON WI 53792
Titolo Testata:
Surgery
fascicolo: 4, volume: 120, anno: 1996,
pagine: 688 - 695
SICI:
0039-6060(1996)120:4<688:TVLEAE>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
POSTOPERATIVE ILEUS; ABDOMINAL-SURGERY; MORPHINE; BUPIVACAINE; ANALGESIA; MOTILITY; RAT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
26
Recensione:
Indirizzi per estratti:
Citazione:
A.M. Scott et al., "THORACIC VERSUS LUMBAR EPIDURAL ANESTHESIAS EFFECT ON PAIN CONTROL AND ILEUS RESOLUTION AFTER RESTORATIVE PROCTOCOLECTOMY", Surgery, 120(4), 1996, pp. 688-695

Abstract

Background. Epidural anesthesia as a perioperative adjunct has been shown to provide superior pain control and has been implicated in more rapid ileus resolution after major abdominal surgery, possibly througha sympatholytic mechanism. Studies suggest that the vertebral level of epidural administration influences these parameters. Methods. One hundred seventy-nine patients (120 male, 59 female; average age, 36 years) underwent restorative proctocolectomy for ulcerative colitis or familial polyposis between 1989 and 1995. Patients were grouped accordingto type of anesthesia. Group THO (n = 53) received thoracic (T6 to T10) epidurals. Group LUM (n = 51) received lumbar (L2 to L4 epidurals, and group PCA (n = 75) received patient-controlled intravenous narcotic analgesia. Patients were compared for complications, perioperative risk factors, postoperative pain and ileus resolution. Results. Epidural narcotics, alone or combined with local anesthetics, were administered for an average of 2 (LUM) to 4 (THO) days without significant complications. infrequent problems related to the epidural catheters included self-limited headaches or back pain (four) and site infections (two). Epidural failure, as measured by conversion to PCA for inadequate pain control, was nor significantly greater for LUM (25 %) than THO (23%). Average pain scores, rated daily on a visual analog scale, were significantly higher (indicating more pain) for PCA patients (4.2) during postoperative days 1 through 5 than for LUM (3.5) (p < 0.05) and for THO (2.4) (p < 0.05). Ileus resolution as determined by stool outputand return of bowel sounds, was significantly faster in THO than in LUM or PCA (p < 0.05). Resolution of ileus was not significantly different between PCA and LUM (p > 0.5). Conclusions. Thoracic epidural analgesia has distinct advantages over both lumbar epidural or traditionalpatient-controlled analgesia in shortening parameters measuring postoperative ileus and in reducing surgical pain. The procedure is safe and associated with low morbidity. Thoracic epidural anesthesia is also economically justifiable and may prove to impact significantly on future postoperative management by reducing length of hospitalization Our data and those of others are most striking in these regards for patients with thoracic catheters, indicating the importance of vertebral level in epidural drug administration.

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Documento generato il 04/07/20 alle ore 17:08:20