Efficiency Evaluation of the Peridural Analgesia Methods After Hemorrhoidectomy

This article presents the results of a comparative assessment of the effectiveness of epidural anesthesia with a combination of local anesthetic and morphine with an automatic syringe, the technique of epidural analgesia in the bolus mode at specified time intervals and at the patient's request, and analgesia in the form of a continuous epidural infusion of 0.5% bipuvicaine solution in combination with a narcotic drug in patients after hemorrhoidectomy. Based on the results of the analysis, it can be concluded that the method of prolonged epidural analgesia in the postoperative period allows achieving good results with the least complications.

Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

Although recent evidence shows that the programmed intermittent epidural bolus can provide improved analgesia compared to continuous epidural infusion during labor, its usefulness in major upper abdominal surgery remains unclear. We evaluated the effect of programmed intermittent epidural bolus versus continuous epidural infusion on the consumption of postoperative rescue opioids, pain intensity, and consumption of local anesthetic by retrospective analysis of data of patients who underwent major upper abdominal surgery under ultrasound-assisted thoracic epidural analgesia between July 2018 and October 2020. The primary outcome was total opioid consumption up to 72 h after surgery. The data of postoperative pain scores, epidural local anesthetic consumption, and adverse events from 193 patients were analyzed (continuous epidural infusion: n = 124, programmed intermittent epidural bolus: n = 69). There was no significant difference in the rescue opioid consumption in the 72-h postoperative period between the groups (33.3 mg [20.0–43.3] vs. 28.3 mg [18.3–43.3], p = 0.375). There were also no significant differences in the pain scores, epidural local anesthetic consumption, and incidence of adverse events. Our findings suggest that the quality of postoperative analgesia and safety following major upper abdominal surgery were comparable between the groups. However, the use of programmed intermittent epidural bolus requires further evaluation.

Programmed intermittent epidural bolus in comparison with continuous epidural infusion for uterine contraction pain relief after caesarean section: a randomised, double-blind clinical trial

Objective Programmed intermittent epidural bolus (PIEB) was reported to provide superior maintenance of labour analgesia with better pain relief, and less motor block than continuous epidural infusion (CEI). Whether this is also evident for uterine contraction pain relief after caesarean section remains unknown. Design Randomised, double blind, positive-control trial. Setting Guangzhou Women and Children’s Medical Center, China Population Parturients scheduled for elective caesarean section under combined spinal-epidural anaesthesia were enrolled. Methods At the end of the surgery, after a similar epidural loading dose given, patients received either PIEB (6 mL every hour) or CEI (6 mL/h) of 0.1% ropivacaine. Main outcome measures The primary outcome was the effectiveness of uterine contraction pain relief during breastfeeding assessed with visual analog scale score (VAS-UD) at the postoperative 36 h. Secondary main outcome was lower extremity motor block (defined as Bromage score > 0). Results One hundred and twenty parturients were studied (PIEB, 60; CEI, 60). The VAS-UD at the postoperative 36 h was significantly lower in the PIEB group than in the CEI group [median (IQR), 30 (20 to 40) mm] compared with the CEI group [40 (30 to 50) mm], with an estimated difference of -10 mm (95% CI -15 to -5 mm; P=0.001). Motor block was higher in the CEI group than in the PIEB group during the study period except 2 h (all P<0.05). Conclusions PIEB provides more effective uterine contraction pain relief and less motor block after caesarean section than CEI.

Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial

Background: One of the most common devastating problems that occur after urethroplasty is erection, which causes surgical complications (fistula, wound dehiscence, and surgical graft failure) and the need for repairing the complications. We attempted to compare the effect of continuous epidural infusion of dexmedetomidine and ropivacaine as a post-surgical erection prevention strategy. Objectives: In this study, we aimed to compare the effect of dexmedetomidine and ropivacaine epidural infusion on the incidence of erection after reconstructive urethral surgery. Methods: An RCT was conducted on 45 patients who were scheduled for reconstructive urethral surgery. They were randomly divided into three groups: (1) control (n = 15), (2) epidural dexmedetomidine (n = 15), (3) and epidural ropivacaine (n = 15). The control group received oral medication after surgery according to the conventional method (cyproterone compound tablets 50 mg BD and diazepam tablets 2 mg TDS for a week) to prevent erection. The DEX group received dexmedetomidine as continuous epidural infusion, and the ROP group received ropivacaine in addition to the conventional method. The occurrence of erection during day and night was recorded separately until the seventh day after surgery. Due to the long-time interval between case selection, participants from different groups were not matched with each other. Results: The incidence of erection in the dexmedetomidine group was lower than that in the ropivacaine group per person (0.87) and significantly lower than in the control group (2.8 per person). Also, there was significantly less erection in the ropivacaine group (1.2 per person) than in the control group. Our study showed that erection after surgery significantly decreased with the continuous epidural infusion of dexmedetomidine and ropivacaine. Conclusions: Dexmedetomidine seems to have a significant preventive effect on erection after reconstructive urethral surgery.

Intermittent epidural boluses vs continuous epidural infusion for labour analgesia: which is superior?

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?

Programmed intermittent epidural boluses (pieb) for labor analgesia: study of the sensor block and effects on maternal motor function

Background. Programmed intermittent epidural boluses (PIEB) technique is a promising approach that demonstrates certain advantages over traditional techniques of epidural analgesia. We compared the dynamics of the sensory block of PIEB + parturient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI) + PCEA for maintenance labor analgesia and the incidence of motor block (MB) in women who received PIEB or traditional techniques. Methods. A total of 165 subjects were studied. All parturients were divided into five groups: manual boluses, PCEA, PCEA + CEI, PIEB + PCEA; levobupivacaine 0.25 mg/mL; 1.25 mg/mL; 0.625 mg/mL. The level of the MB was evaluated by the classic Bromage scale (0-1-2-3). The level of the sensor block was evaluated by the pin-prick test. Results. MB was reported in 80% in group 1 120 min after analgesia, 78% and 52% in groups 2 and 3 at the 150th min (p 0.001); in group 4, the MB frequency was 6% 15 min after the start and was increasing to 40% at full cervical dilation (p 0.001). In group 5, the relative MB frequency did not exceed 10% at the 120th min and was 0% at full cervical dilation (p 0.00001). The results indicate that in the PIEB group, the level of sensory block in patients was higher 15 min after the start of analgesia and remained so until the end of the observation period [median PIEB Th5 versus Th8 in the CEI group, (p 0.0004)]. Conclusions. PIEB + PCEA technique maintained a consistently high level of sensor block throughout the study compared to PCEA + CEI, which ensured effective analgesia in the first and second stages of labor with minimal MB.