Objective To compare the effect of intravenous and epidural analgesia on postoperative complications after abdominal and thoracic surgery. Methods A literature search was conducted by using computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1985 to Jan 2009. Further searches for articles were conducted by checking all references describing postoperative complications with intravenous and epidural anesthesia after abdominal and thoracic surgery. All included randomized controlled trials (RCTs) were assessed and data were extracted by the standard of Cochrane systematic review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results Thirteen RCTs involving 3 055 patients met the inclusion criteria. The results of meta-analyses showed that, a) pulmonary complications and lung function: patient-controlled epidural analgesia can significantly decrease the incidence of pneumonia (RR=0.66, 95%CI 0.53 to 0.83) and improve the FEV1 (WMD=0.17, 95%CI 0.05 to 0.29) and FVC (WMD=0.21, 95%CI 0.1 to 0.32) of lung function after abdominal and thoracic surgery, but no differences in decreasing postoperative respiratory failure (RR=0.77, 95%CI 0.58 to 1.02) and prolonged ventilation (RR=0.75, 95%CI 0.51 to 1.13) compared with intravenous analgesia; b) cardiovascular event: epidural analgesia could significantly decrease the incidence of myocardial infarction (RR=0.58, 95%CI 0.35 to 0.95) and arrhythmia (RR=0.64, 95%CI 0.47 to 0.88) than the control group, but could not better reduce the risk of heart failure (RR=0.79, 95%CI 0.47 to 1.34) and hypotension (RR=1.21, 95%CI 0.63 to 2.29); and c) Other complications: epidural and intravenous analgesia had no difference in decreasing the risk of postoperative renal insufficient (RR=0.78, 95%CI 0.53 to 1.14), gastrointestinal hemorrhage (RR=0.78, 95%CI 0.49 to 1.23), infection (RR=0.89, 95%CI 0.70 to 1.12) and nausea (RR=1.03, 95%CI 0.38 to 2.81). Conclusions Epidural analgesia can obviously decrease the risk of pneumonia, myocardial infarction and severe arrhythmia, and can improve the lung function after abdominal or thoracic surgery.
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
Objective To observe the effects of epidural anaesthesia (EA) and general anaesthesia (GA) on the changes of plasma epinephrine (E) and norepinephrine (NE) during laparoscopic cholecystectomy (LC). Methods Thirty patients undergoing elective LC were randomly divided into GA group (n＝15) and EA group (n＝15). The concentrations of plasma NE and E were measured at the following phases: before anaesthesia, before introducing pneumoperitoneum, during pneumoperitoneum, and at the end of operation. Results In EA group, the concentrations of NE weren′t significantly different at each phase, the concentrations of E significantly increased before and during pneumoperitoneum (Ｐ＜0.05) and returned to the baseline at the end of operation (Ｐ＞0.05). In GA group, the concentrations of NE and E didn′t change significantly before pneumoperitoneum, but increased during pneumoperitoneum (Ｐ＜0.05) and E didn′t return to the baseline at the end of operation (Ｐ＜0.05). The E concentrations of EA group was higher than that of GA group before pneumoperitoneum, but the NE concentration of EA group was lower than that of GA group during pneumoperitoneum (Ｐ＜0.05). Conclusion Both groups has significant stress reaction, but the stress reaction of EA group is weaker than that of GA group during LC.
Objective To study the effect of the allogeneic bone sheet that has been treated by the freezedrying and radiation sterilization in preventing the epidural adhesion after laminectomy in sheep. Methods Laminectomy was performed on L3,4and L4,5 of 12 adult male sheep. Afteroperation, one site of L3,4 or L4,5was covered by the allogeneicbone sheet in “H” shape after the freeze-drying and radiation sterilization treatment; and the other site was used as a control. The sheep were killed and the specimens were retrieved at 4，8，12，16，20 and 24 weeks after operation to observe the scar formation process. X-ray andCT scan were performed in the segments of L3,4and L4,5at 4 and 24weeks. Results Four weeks after operation, the position and the shape of the allogeneic bone sheet were good in condition, and no lumbar spinal stenosis or compression of the dura was found in the experimental sections. Twentyfour weeks after operation theexamination on the experimental sections revealed that the vertebral canal reconstruction was completed, the allograft was absorbed almost completely, and inosculation with the lamina of the vertebra and the shape of the lumbar spine were good, with no fibroid tissues found in the epidural area. Compared with the control segment, the dura adhesion degree in the laminoplasty segment was significantly decreased (Plt;0.01), and the dura sac remained in a good shape. There was no obvious compression on the dura. Conclusion The allogeneic bone sheet after the treatment of freeze-drying and radiation sterilization can effectively reduce the scar formation after laminectomy and prevent postoperative recurrence of the spinal stenosis.
In order to find an ideal biological material to prevent peridural adhesion following laminectomy, 30 rabbits were used as animal model, in each of which 2 defects with a size of 1 cm x 0.5 cm were made following laminectomy of L3, L5 spine. One of the defects was covered extradurally with chitosan, gelatin foam or PLA membrane respectively, while the other defect was exposed as control. All of these animals were sacrificed on the 2nd, 4th, 6th, 8th and 10th week after operation, and the extradural fibrosis and adhesion of every animal were evaluated by gross observation and histological examinations. It was revealed that in the chitosan and PLA membrane groups, the extradural tissue was smooth without thickening and there was no fibrous proliferation or adhesion in the epidural cavity, and that in the chitosan group, the growth of fibroblast was restrained but the growth of the epithelial cells was promoted significantly, thus, wound healing was rapid. In the control group and gelatin foam group, obvious extradural fibrosis and adhesion were observed and the extradural space had almost disappeared. Therefore, it was concluded that the biodegradable PLA membrane and chitosan were both an ideal material in the prevention of postoperative epidural adhesion.
Objective To systematically evaluate the effect of epidural analgesia on prognosis after intestinal surgery. Methods Such databases as PubMed, EBSCO, Springer, Ovid and CNKI were searched to identify randomized controlled trials (RCTs) about the effects of epidural analgesia on prognosis after intestinal surgery published from 1985 to 2010. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Handbook, and then the meta-analyses were conducted by using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that compared with the patient controlled analgesia (PCA), the patient controlled epidural analgesia (PCEA) significantly reduced the waiting time for having first flatus, first defecation, and the length of hospital stay (MD= –1.07, 95%CI –1.63 to –0.50; MD= –0.63, 95%CI –1.19 to –0.08; MD= –1.36, 95%CI –2.28 to –0.44; respectively), lowered the frequency of vomiting on the first and second day after operation (OR=0.33, 95%CI 0.13 to 0.82; OR=0.3, 95%CI 0.13 to 0.84; respectively), and obviously declined the visual analog scale (VAS) scores of rest pain on the first, second and third day after operation (MD= –26.60, 95%CI –33.06 to –20.15; MD= –25.98, 95%CI –30.98 to –20.97; MD= –15.59, 95%CI –27.29 to –3.88; respectively), and the VAS scores of motion pain on the first, second and third day after operation (MD= –26.00, 95%CI –36.00 to –16.00; MD= –27.89, 95%CI –35.70 to –20.08; MD= –11.79, 95%CI –21.28 to –2.30; respectively). There were no significant differences between the two groups in the incidence of urinary tract infection, urinary retention, anastomotic leak and ileus. Conclusion PCEA significantly reduces the waiting time for having first flatus and first feces, the length of hospital stay, the VAS scores of pain, and the incidence of postoperative vomiting.
Objective To systematically review the effectiveness and safety of thoracic epidural analesis (TEA) for postoperative complications after cardiac surgery. Methods Such databases as PubMed, Science Citation Index, EMbase, The Cochrane Library, CNKI and CBM were electronically searched from inception to October 2012 for collecting the randomized controlled trials on the effectiveness and safety of thoracic epidural analgesisa for postoperative complications after cardiac surgery. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 14 studies were eligible, involving 1 942 patients. The results of meta-analysis showed that, TEA combined with general anesthesia (GA) was superior to GA alone in reducing the incidences of myocardial ischemia/infarction (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), respiratory complications (RR=0.55, 95%CI 0.40 to 0.75, P=0.000 1), supraventricular arrhythmias (RR=0.64, 95%CI 0.47 to 0.88, P=0.005), and duration of mechanical ventilation (MD= –2.15, 95%CI –3.72 to –0.58, P=0.007), with significant differences. Conclusions Current evidence shows that, TEA after surgery is effective in reducing the incidences of myocardial ischemia/infarction, respiratory complications, supraventricular arrhythmias, and duration of mechanical ventilation. There is the lack of data on the adverse events of TEA (mainly referring to epidural hematoma). Due to limited quality and quantity of the included studies, patients’ conditions should be fully considered before applying TEA in clinical practice.
ObjectiveTo systematically review the efficacy of paravertebral block (PVB) versus thoracic epidural block (TEB) for post-thoracotomy analgesia. MethodsWe electronically searched databases including The Cochrane Library (Issue 9, 2013), PubMed, EMbase, Springer, CNKI, CBM, VIP and WanFang Data from 1980 to September 2013, to collect randomized controlled trials (RCTs) of PVB versus TEB for post-thoracotomy pain management. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsThirteen RCTs involving 608 patients were included. The results of meta-analysis showed that:the PVB group got higher VAS score at 48 h than the TEB group (WMD=-0.36, 95%CI -0.54 to -0.71), but more patients of the PVB group chosen remedial method to release pain in epidural than in paravertebral. In addition, there were no differences in VAS scores at 6 h and 24 h between two groups. As for the analgesia related complication:compared with the TEB group, the PVB group has lower rate of hypotension (RR=0.18, 95%CI 0.08 to 0.41), urinary retention (RR=0.24, 95%CI 0.11 to 0.54), nausea and vomiting (RR=0.42, 95%CI 0.25 to 0.70). There were no significant differences between two groups in postoperative pulmonary complication (RR=0.52, 95%CI 0.10 to 2.76), postoperative FEV1 level (WMD=2.93, 95%CI -4.52 to 10.38) and duration of hospital stay (WMD=-0.19, 95%CI -0.89 to 0.50). The PVB group had lower risk of chronic pain than that of the TEB group (RD=-0.12, 95%CI -0.23 to -0.01). ConclusionCurrent evidence shows PVB has the similar efficacy as TEB in post-thoracotomy pain management, with lower risk of analgesia related complication and lower risk of post-thoracotomy chronic pain. Due to limited quality and quantity of the included studies, more high quality and large-scale RCTs are needed to verify the above conclusion.
Objective To evaluate the effectiveness of intravenous patient-controlled analgesia versus epidural patient-controlled analgesia for postoperative analgesia, sedation, and the incidence of side effects. Methods We searched the specialized trials registered in the Cochrane anesthesia group, The Cochrane Library (CCTR), MEDLINE (1966 to Sept. 2008), EMbase (1966 to Sept. 2008), PubMed (1966 to Sept. 2008), and handsearched some Chinese anesthesia Journals and Clinical anesthesia journals. Randomized controlled trials (RCTs) and quasi-RCTs of intravenous versus epidural analgesia for post-operation were included. The quality of the trials was critically assessed. RevMan 4.2.8 software was used for meta-analyses. Results Thirteen RCTs involving 580 patients of intravenous versus epidural analgesia for post-operation were included. The results of meta-analyses showed that there were no significant differences in postoperative analgesia and sedation at the hour-points of 2nd, 4th, 8th, 12th, and 24th hours after operation. There were no significant differences in plasma fentanyl concentration in the two groups on the same analgesia effects. There were also no significant differences in side effects. Conclusion Both intravenous patient-controlled analgesia and epidural patient-controlled analgesia have the same clinical effects. Compared with epidural patient-controlled analgesia, intravenous patient-controlled analgesia has fewer side effects and is more convenient. At the same time, it can reduce more costs of hospitalization. But because of the low quality and small sample size of the included studies, more well-designed, large scale, randomized controlled trials are needed.
Objective To explore the effect of epidural analgesia for labor on maternal temperature and the newborns. Methods This randomized trial was performed in West China Second Hospital between December 2015 and July 2016. Fifty puerperants were randomly divided into epidural analgesia (EA) group (natural labor under EA, n=25) or the control group (natural labor using Ramaze breathing method, n=25). Maternal tympanic temperature was recorded once per hour after treating with painless labor or blank control. The serum interleukin-1 beta (IL-1β) and heat shock protein 70 (HSP70) level were measured from the blood of the umbilical cord after the delivery. Apgar scores of the newborns were also recorded. Results There was a significant difference in the temperature between EA and control group one hour after the treatment of painless labor [ (36.9±0.7) and (36.4±0.5)℃]. The level of serum IL-1β and HSP70 were significantly higher in EA group [IL-1β: (0.308±0.036) ng/mL; HSP70: 1.175±0.196] than those in the control group [IL-1β: (0.244±0.031) ng/mL; HSP70: 0.935±0.308] (P<0.05). However, no significant difference was found in the neonatal Apgar score (P>0.05). Conclusions The increase of maternal temperature is greater in the EA labor puerperants compared with that in the controls, which may be related to the increase of IL-1β and HSP70. No adverse effect of labor analgesia on new borns is found