Analgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients?
|
|
- Diane Banks
- 5 years ago
- Views:
Transcription
1 Analgesia after c delivery - wound infusions, tap blocks and intrathecal opioids; what more can we offer our patients? Ashraf S Habib, MBBCh, MSc, MHSc, FRCA Associate Professor of Anesthesiology Interim Chief, Division of Women s Anesthesia OAA Three Day Course, November 2014
2 Outcome Rank Relative Value Pain During Caesarean 8.4 ± ± 18 Pain After Caesarean 8.3 ± ± 10 Vomiting 7.8 ± ± 7 Nausea 6.8 ± ± 7 Cramping 6.0 ± ± 8 Itching 5.6 ± ± 8 Shivering 4.6 ± ± 6 Anxiety 4.1 ± ± 4 Somnolence 2.9 ± ± 3 Carvalho B. Anesth Analg 2005; 101:
3 Does it matter? Better postoperative analgesia Faster ambulation Improved breast feeding success Higher patient satisfaction Reduced incidence of persistent pain and maternal depression
4 Persistent Pain after CD Author Number of CD Time of data collection after delivery Incidence of persistent pain Nikolajsen months 12.3 % Eisenach weeks 9.2 % Sng Months 9.2 % Kainu year 18 % Severity of acute pain was a significant predictor of persistent pain Nicolajsen L. Acta Anaesthesiol Scand 2004; 48: Eisenach JC. Pain 2008; 140: Sng BL. Anaesth Intensive Care 2009; 37: Kainu JP. Int J Obstet Anesth 2010; 19: 4-9
5 Modalities for Post-Caesarean Opioids Analgesia Systemic Adjuncts Local Anaesthetic Techniques Neuraxial Adjuncts
6
7 Modalities for Post-Caesarean Opioids Analgesia Systemic Adjuncts Local Anaesthetic Techniques Neuraxial Adjuncts
8 Neuraxial vs. Parenteral Opioids Meta-analysis (10 studies): time to first analgesia pain scores pruritus (RR=2.7) and nausea (RR=2) sedation with parenteral opioids Bonnet MP. Eur J Pain 2010; 14: 894.e e9
9 Neuraxial vs. oral Opioids Intrathecal morphine vs. regular oral oxycodone need for analgesics/high pain scores patient satisfaction pruritus (87 % vs. 56 %, p=0.001) McDonnell NJ. Int J Obstet Anesth 2010; 19: 16-23
10 PCEA Morphine Use (mg) Dose Response of Neuraxial Morphine Epidural Morphine Intrathecal Morphine P<0.05 vs. 2.5, 3.75, 5 mg P<0.05 vs and 5 mg Epidural Morphine Dose (mg) Intrathecal Morphine Dose (μg) Palmer CM. Anesth Analg 2000; 90: Palmer C. Anesthesiology 1999; 90:
11 Husaini SW. Br J Anaesth 1998; 81: Kelly MC. Anaesthesia 1998; 53: Sibilla C. Int J Obstet Anesth 1997; 6: 43-8 Bloor GK. Int J Obstet Anesth 1999; 8: Neuraxial Diamorphine IT diamorphine as effective as epidural morphine IT: μg Epidural: 2-3 mg
12 Opioid Consumption Single Dose EREM vs. mg Morphine P=0.012 Carvalho B. Anesth Analg 2007;105:
13 CSE E Lidocaine % 70 P= P=0.02 P= Vomiting Need for Oxygen Hypotension Higher Cmax with E (P=0.038) Ralls LA. Anesth Analg 2011; 113: 251-8
14 Side Effects of Neuraxial Opioids Pruritus (40-90 %) PONV (30-50 %) Urinary Retention (22-58 %) Respiratory Depression (0-0.9 %)
15 Obesity Class III 17.6 % Obesity Class II 17.1 % Incidence of Respiratory Depression (95 % CI)= 0 (0, 0.07) % Obesity Class I 28.3 % Overweight 28.4 % Normal Weight 8.5 % % n=5036, mean BMI = 34 kg/m 2 Crowgey T. Anesth Analg 2013; 117:
16 Modalities for Post-Caesarean Opioids Analgesia Systemic Adjuncts Local Anaesthetic Techniques Neuraxial Adjuncts
17 NSAIDS Rectal, oral, IV, wound instillation Regular administration % opioid sparing 30 % reduction in relative risk of PONV, sedation RID= % Jakobi P. Isr Med Assoc J 2006; 8: Elia N. Anesthesiology 2005; 103: Marrett E. Anesthesiology 2005; 102:
18 Cox-2 inhibitors RID = % Celecoxib 400 mg? Analgesic Efficacy Valdecoxib: not effective Gardiner SJ. Br J Pharmacol 2006; 61: Fong WP. Br. J. Anaesth. (2008) 100 (6): Lee L. Anaesthesia 2004; 59: Carvalho B. Anesth Analg 2006; 103: Hale. Hum Lact 2004; 20:
19 Paracetamol Limited effect on uterine pain RID= 1-2 % IV paracetamol (1G Q 6 hrs) similar analgesia to ibuprofen 400 mg Q 6 hrs Proparacetamol did not provide better analgesia or enhance diclofenac analgesia Paracetamol/diclofenac 38% less morphine than paracetamol Alhashemi JA. Can J Anesth 2006; 53: Siddiq SM. Reg Anesth Pain Med 2001; 26: Munishankar B. Int J Obstet Anesth 2008; 17: 9-14 Hale. Hum Lact 2004; 20:
20 Combination > acetaminophen alone in 85 % of studies Combination > NSAIDs alone in 64 % of studies Pain scores reduced by 35 %/ 37 % over acetaminophen/ NSAIDs Analgesic needs reduced by 39 %/ 31 % over acetaminophen/ NSAIDs Ong CKS. Anesth Analg 2010; 10:
21 Gabapentin Pain scores on movement Pain scores at rest Umbilical V: Maternal V=0.86 RID=2.34 % Moore A. Anesth Analg 2010; 112: Short J. Anesth Analg 2012; 115:
22 Ketamine 10 mg IV following Delivery 0.5mg/kg IM followed by 2 μg/kg/min for 12 h Bauchat JR. Int J Obstet Anesth 2011; 20: 3-9 Suppa E. Minerva Anesthesiol 2012; 78:
23 Tramadol RID= 2.24 % More need for rescue and more side effects compared with naproxen Diclofenac/tramadol > Diclofenac/paracetamol with more side effects LLett KF. Br J Clin Pharmacol 2008; 65: Sammour RN. Int J Gynaecol Obstet 2011;113:144-7 Mitra S. Acta Anaesthesiol Scand 2012; 56:
24 Dexamethasone Early Pain (0-4 h) Late Pain (24 h) Need for rescue analgesics Allen TK. Anesth Analg 2012; 114:
25 Modalities for Post-Caesarean Opioids Analgesia Systemic Adjuncts Local Anaesthetic Techniques Neuraxial Adjuncts
26 Local Anesthetic infiltration Minimal benefit from single infiltration No benefit with long-acting neuraxial opioids? Extended release bupivacaine Trotter T. Anaesthesia 1991; 46: Pavy T. Int J Obstet Anesth 1994; 3: Niklasson B. Acta Obstet Gynecol Scand 2012; 91:
27 Continuous LA Wound Infiltration > Saline Infiltration Above the fascia (4 studies) % Opioid sparing Below the fascia (1 study) No opioid sparing < Epidural Levobupivacaine Below the fascia Fredman B. Anesth Analg 2000; 91: Givens VA. Am J Obstet Gynecol 2002; 186: Mecklem DW. Aust NZ J Obstet Gynecol 1995; 35: Kainu JP. Int J Obstet Anesth 2012; 21: Lavand homme P. Anesthesiology 2007; 106: Ranta P. Int J Obstet Anesth 2006; 15:
28 Continuous LA Wound Infiltration < Systemic NSAIDs Above the fascia? Neuraxial Opioids < Intrathecal Morphine Below the fascia > Epidural Morphine Below the fascia Zohar E. J Clin Anesth 2006; 18: Magnani E. Clin Exp Obstet Gynecol 2006;33:223 5 Kainu JP. Int J Obstet Anesth 2012; 21: O Neill P. Anesth Analg 2012; 114:
29 Rackelboom T. Obstet Gynecol 2010; 116:
30 Intraperitoneal LA Kahokehr A. ANZ J Surg 2011; 81: Shahin AY. Clin J Pain 2010; 26: 121-7
31 Local NSAIDs Infiltration Lavand homme P. Anesthesiology 2007; 106:
32 IL-6 (P=0.01) and IL-10 (0=0.005) with K vs. B Carvalho B. J Pain 2013; 14: 48-56
33 TAP Block
34 Opioid Consumption Pain on Movement No ITM ITM Vs. ITM Mishriky BM. Can J Anesth 2012;59:766-78
35 Mirza F. Can J Anesth 2013; 60:
36 Lidocaine Patch Habib AS. Anesth Analg 2009; 108:
37 Modalities for Post-Caesarean Opioids Analgesia Systemic Adjuncts Local Anaesthetic Techniques Neuraxial Adjuncts
38 Neuraxial Adjuncts Neostigmine, clonidine, ketamine, magnesium, etc.. Modest analgesic benefit Side effects Might reduce hyperalgesia and sensitization
39 Prediction of Post CS Pain QSTs Temporal summation DNIC Electrical pain Heat pain Scar Hyperalgesia pain scale (VAS) (0 = no pain, 10 = worst pain imaginable) at rest (R), while sitting (S) and for uterine cramping pain (U) at 12, 24 and 48 h following Caesarean delivery. With the exception of VAS-R24, pain scores were always higher in women with scar hyperalgesia. SHA = women with preoperative scar hyperalgesia (index > 0). No SHA = women with no preoperative scar hyperalgesia. *p < 0.05, **p < range ( ). The incidence and extent of postoperative WHA index were significantly higher in women with preoperative SHA compared with those with no preoperative SHA (Table 2). There was no Buhagiar LM. J Anaesthesiol Clin Pharmacol 2013; 29: Buhagiar LM. J Anaesthesiol Clin Pharmacol. 2011;27: Nielsen PR. Acta Anaesthesiol Scand. 2007;51:582-6 Ortner CM. Eur J Pain 2013; 17: Garnot M. Anesthesiology 2003; 98: Figure 2 Correlation between preoperative scar hyperalgesia (SHA) and post-operative pain while sitting at 48 h (VAS-S48). Solid line is the correlation between VAS-S48 and a cut-off for SHA index (p < 0.002, r = 0.247). Dashed and doted line is the correlation between VAS-S48 and SHA, if VA (p (p di m n 68 w re (T 3 W (A ce ce w 2. p [0 di sc be in su bo
40 Prediction of Post CS Pain Questionnaires STAI Three simple questions Anxiety level Anticipated pain Anticipated analgesic need Pan PH. Anesthesiology 2013;118: Pan PH. Anesthesiology 2006; 104:
41 Regimen at Duke Routine: Neuraxial Morphine Regular NSAIDs + Paracetamol PRN Oxycodone Rescue: TAP blocks Lidocaine patches Gabapentin
42 Regimen at Duke Opioid dependent parturients: PCEA TAP blocks Neuraxial Clonidine Gabapentin
43 Conclusions Optimal analgesia important short and long term Multimodal approach Targeted therapy for high risk patients
44
45
Post Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark
Post Caesarean Analgesia An Update Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post caesarean analgesia No Conflicts of Interests Neuraxial opioids Multimodal therapy Plan
More informationCAESAREAN SECTION Brian Fredman
CHAPTER 3 GYNAECOLOGICAL SURGERY CAESAREAN SECTION Brian Fredman Review of evidence: surgical site infusion Of the seven studies on surgical site local anaesthetic infusion after Caesarean section performed
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationWhat s New in Post-Cesarean Analgesia?
Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24
More informationContinuous Wound Infusion and Postoperative Pain Current status?
Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationPost-operative Analgesia for Caesarean Section
Post-operative Analgesia for Caesarean Section Introduction Good quality analgesia after any surgery leads to earlier mobilisation, fewer pulmonary and cardiac complications, a reduced risk of DVT and
More informationUpdate Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationRichard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY,
Richard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY, USA Disclosures Off label use: Fentanyl, Sufentanil IT
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
More informationMr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government
Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia
More informationChronic pain after childbirth. Petter Kainu Split
Chronic pain after childbirth Petter Kainu Split 9.5.13 Backround: 128 milj. births per year world wide 18.5 milj. caesarean sections (WHO 2008) 234 milj. surgical operations per year (WHO 2004) Chronic
More informationOB Div News March 2009
OB Div News March 2009 Several articles in this month s review have come from Canadian institutions. In spite of my pride in being Canadian, which was enhanced during the Olympics, this is purely coincidental.
More informationInitiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany
Initiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany Kenneth E Nelson, M.D. Associate Professor Wake Forest University, North Carolina, USA Initiating
More informationPost-caesarean analgesia. Genevieve Goulding Royal Brisbane & Women's Hospital 1
Post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's Hospital 1 Contemporary challenges & barriers to providing optimal post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's
More informationPain relief after cesarean section: Oral methadone vs. intramuscular pethidine
Original Article Pain relief after cesarean section: Oral methadone vs. intramuscular pethidine Azar Danesh Shahraki, 1 Mitra Jabalameli, 2 Somayeh Ghaedi 3 1 Associate Professor, Department of Obstetrics
More informationParecoxib, Celecoxib and Paracetamol for Post Caesarean Analgesia: A Randomised Controlled Trial
Parecoxib, Celecoxib and Paracetamol for Post Caesarean Analgesia: A Randomised Controlled Trial McDonnell NJ, Paech MJ, Baber C, Nathan E Clinical Associate Professor Nolan McDonnell School of Medicine
More informationENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT
ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES
More informationNerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS
Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV
More informationCurrent Management of Labour Analgesia Epidural or CSE, Bolus or Infusions?
Current Management of Labour Analgesia Epidural or CSE, Bolus or Infusions? Dr Mark Esler Queen Charlotte s and Chelsea Hospital Imperial College Healthcare NHS Trust 2 nd October 2013 2 kangaroos and
More informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationMorphine for post-caesarean section analgesia: intrathecal, epidural or intravenous?
O r i g i n a l A r t i c l e Singapore Med J 2005; 46(8) : 392 Morphine for post-caesarean section analgesia: intrathecal, epidural or intravenous? Y Lim, S Jha, A T Sia, N Rawal ABSTRACT Introduction:
More informationCesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors
Cesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors Cristian Arzola MD MSc Department of Anesthesia and Pain Management Mount Sinai Hospital and University of
More informationAs laparoscopic surgeries are gaining popularity, Original Article. Maharjan SK 1, Shrestha S 2 1. Introduction
, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 Original Article Maharjan SK 1, Shrestha S 2 1 Associate Professor, 2 Assistant Professor, Department of Anaesthesiology and Intensive Care Kathmandu Medical College,
More informationRole and safety of epidural analgesia
Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationSenior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view
Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal
More informationEpidural Analgesia: The Best Mix
Epidural Analgesia: The Best Mix Clinical Associate Professor Nolan McDonnell FANZCA MClinRes Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco, Western Australia
More informationSpinal Anaesthesia for Caesarean Delivery. Pervez Sultan University College London Hospital
Spinal Anaesthesia for Caesarean Delivery Pervez Sultan University College London Hospital Disclosures How to Deliver an Evidence- Based Spinal Anaesthetic CSE vs. spinal Block height assessment Drugs
More informationAnaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation
Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee
More informationLearning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16
Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center
More informationHow to reduce failure rate of regional anaesthesia for caesarean section? Mike Kinsella St Michael s Hospital, Bristol 4 th November 2010
How to reduce failure rate of regional anaesthesia for caesarean section? Mike Kinsella St Michael s Hospital, Bristol 4 th November 2010 Define failure GA conversion; RCoA standards Cat 4
More informationA COMPARATIVE STUDY OF NEURAXIAL BLOCK FOR POST-CESAREAN ANALGESIA AND SIDE EFFECTS: INTRATHECAL VS EPIDURAL MORPHINE
A COMPARATIVE STUDY OF NEURAXIAL BLOCK FOR POST-CESAREAN ANALGESIA AND SIDE EFFECTS: INTRATHECAL VS EPIDURAL MORPHINE Chung M Chan 1, Saw K Cheah 1, Muhammad Maaya 1, Rufinah Teo 1, Su Y Loo 2, Thohiroh
More informationLabor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
More informationPre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery
Page 1 of 5 Anaesthetics & Critical Care Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery B Lim 1, SY Thong
More informationRegional Anaesthesia for Caesarean Section Warwick D. Ngan Kee
Regional Anaesthesia for Caesarean Section Warwick D. Ngan Kee Chair, Department of Anesthesiology Sidra Medicine Doha, Qatar D I S C L O S U R E S No financial disclosures No industry affiliations No
More informationPresentation objectives. Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient
Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient Ewan McNicol PharmD, MS Presentation objectives Outline principles for management of acute pain, with focus on perioperative
More informationADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management. March 21, 2013
ADE and Harm Collaborative: Reducing ADEs and harm associated with opioids - Safer post-operative pain management March 21, 2013 Agenda, March 21, 2013 Welcome Collaborative education overview Post-operative
More informationIn a previous study from our institution, we found
A Randomized, Double-Blind, Placebo-Controlled Trial of Morphine Analgesia After Vaginal Delivery Alison Macarthur, MD, MSc* Charles Imarengiaye, MD Luminita Tureanu, MD Kristi Downey, MSc* BACKGROUND:
More informationRECENT ADVANCES IN ANALGESIA
4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria
More informationBritish Journal of Anaesthesia 97 (3): (2006) doi: /bja/ael182 Advance Access publication July 21, 2006
British Journal of Anaesthesia 97 (3): 365 70 (2006) doi:10.1093/bja/ael182 Advance Access publication July 21, 2006 The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative
More informationEvaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study
Original article: Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study RajulSubhash Karmakar 1, ShishirRamachandra Sonkusale 1* 1Associate Professor,
More informationAcute Pain Management in the Opioid Tolerant Patient. Objectives. Opioids. The participant will be able to define opioid tolerance
Acute Pain Management in the Opioid Tolerant Patient Kathleen M. Colfer, MSN, RN-BC Clinical Nurse Specialist Acute Pain Management Service Department of Anesthesiology Thomas Jefferson University Hospital
More informationManagement of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017
Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being
More informationOBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
British Journal of Anaesthesia 98 (2): 241 5 (2007) doi:10.1093/bja/ael346 Advance Access publication January 8, 2007 OBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
More informationEfficacy of Transversus Abdominis Plane Block versus Epidural Analgesia in Pain Management Following Lower Abdominal Surgery
Med. J. Cairo Univ., Vol. 85, No. 6, September: 2231-2235, 2017 www.medicaljournalofcairouniversity.net Efficacy of Transversus Abdominis Plane Block versus Epidural Analgesia in Pain Management Following
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationCesarean delivery is a common intervention performed
Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study Manon Lalmand, MD,* Madeleine Wilwerth,
More informationObjectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE
Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation
More informationSwiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C.
CSE s for Labor Analgesia PRO! Swiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C. Tsen, MD Director of
More informationMETA-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY
META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY RESIDENT RESEARCH EXCHANGE DAY MAY 30 TH, 2014 SUPERVISOR: DR. JAMES PAUL SUSAN JO PGY4 SUZANNE LAMBERT PGY4 ADA HINDLE PGY4 INTRODUCTION
More informationWhat s new in obstetric anesthesia?
SAOA 2013 - SPRING MEETING BERN What s new in obstetric anesthesia? PD Dr. Med Georges Savoldelli Médecin Adjoint Unité d anesthésiologie gynéco-obstétricale Service d Anesthésiologie, HUG An objectively
More informationCase Discussions Cynthia A. Wong, M.D.
Case Discussions Cynthia A. Wong, M.D. Association des Anesthѐsiologistes du Quѐbec April 2014 CASE 1 Maternal Mortality Lewis G (ed). CEMACH 2007. Saving Mothers Lives 2003-2005 Pregnancy Complications
More informationIntravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC
Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.
More informationRegional anaesthesia in paediatric day case surgery. PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden
Regional anaesthesia in paediatric day case surgery PA Lönnqvist Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Ambulatory surgery in children Out-patient surgery in children did
More informationCombined spinalepidural. epidural analgesia in labour (review) By Neda Taghizadeh
Combined spinalepidural versus epidural analgesia in labour (review) By Neda Taghizadeh Cochrane review Cochrane collaboration was founded in 1993 and is named after Archie Cochrane (1909-1988), British
More informationKayalvizhi 1, J. Radhika 1* Original Research Article. Abstract
Original Research Article Comparative evaluation of safety and efficacy of epidural bupivacaine with morphine and ketamine vs epidural bupivacaine with morphine alone for postoperative analgesia Kayalvizhi
More informationThe right drug and dose for neuraxial labour analgesia
(Acta Anaesth. Belg., 2006, 57, 395-399) The right drug and dose for neuraxial labour analgesia P. Y. DEWANDRE INTRODUCTION Neuraxial analgesia has been demonstrated for many years to be the only safe
More informationA comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section
TRANSVERSUS THE IRAQI POSTGRADUATE ABDOMINIS MEDICAL PARENTRAL JOURNAL ANALGESIA A comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section
More informationCorresponding author: A. Konstantatos
A randomized trial to compare pain control using oral analgesia with epidural analgesia after cesarean section following combined spinal-epidural anesthesia T.D. Zhong 1, Q. Liu 1, J.N. Zhao 1, H.W. Wang
More informationRegional Anaesthesia for Caesarean Section
Regional Anaesthesia for Caesarean Section "The Best Recipe" Warwick D. Ngan Kee Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong What I will not do. Magic recipes One shoe to fit
More informationHow to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium
How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium No conflict of interest to declare. Does severe acute postoperative pain still
More informationInternational Journal of Pain & Relief. Department of Anesthesiology, the University Of Arkansas for Medical Sciences, Little Rock, AR, USA
International Journal of Pain & Relief Research Article A Retrospective Analysis of the Effects of Transversus Abdominis Plane Blocks With and Without Analgesic Ketamine in Multimodal Analgesia Regimens
More informationAddition of fentanyl to the ultrasound-guided transversus abdominis plane block does not improve analgesia following cesarean delivery
EXPERIMENTAL AND THERAPEUTIC MEDICINE 11: 1441-1446, 2016 Addition of fentanyl to the ultrasound-guided transversus abdominis plane block does not improve analgesia following cesarean delivery LI ZHONG
More informationCaesarean section wound infiltration with local anaesthetic for postoperative pain relief any benefit?
Caesarean section wound infiltration with local anaesthetic for postoperative pain relief any benefit? Anthony Akinloye Bamigboye, George Justus Hofmeyr Delivery by caesarean section (CS) is becoming more
More informationScreening - inclusion criteria
A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Patient code (local): Room number: Screening - inclusion criteria
More informationPatient-controlled analgesia: epidural fentanyl and i.v. morphine compared after Caesarean section
British Journal of Anaesthesia 82 (3): 366 70 (1999) Patient-controlled analgesia: epidural fentanyl and i.v. morphine compared after Caesarean section D. W. Cooper, U. Saleh, M. Taylor, S. Whyte, D. Ryall,
More informationScreening - inclusion criteria
PAIN OUT Community research EU ROP EAN COMMISSION A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Room number: Screening
More informationProfessor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden
Professor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden Infiltrative techniques in perioperative pain lecture outline Why
More informationSCIENTIFIC ARTICLES. Wirzafeldi Sawi * and Choy YC ** Abstract
SCIENTIFIC ARTICLES A COMPARATIVE STUDY OF POST OPERATIVE ANALGESIA, SIDE EFFECTS PROFILE AND PATIENT SATISFACTION USING INTRATHECAL FENTANYL WITH AND WITHOUT MORPHINE 0.1 MG IN CAESAREAN SECTION Wirzafeldi
More informationIs There an Ideal Regimen for CPNB?
Is There an Ideal Regimen for CPNB? Dr Eric Albrecht, MD, DESA Department of Anesthesiology, CHUV 2nd SARA Annual Symposium June 2013 Manuel pratique d ALR échoguidé, Elsevier Masson, Paris, 2013 Albrecht
More informationGUIDELINEs ON PAIN MANAGEMENT IN UROLOGY
GUIDELINEs ON PAIN MANAGEMENT IN UROLOGY (Text update March 2009) P. ader (chair), D. Echtle, V. Fonteyne, G. De Meerleer, E.G. Papaioannou, J.H. Vranken General principles of cancer pain management The
More informationDoes Anesthesia influence Cancer recurrence? Dr Ian McConachie FRCA FRCPC London, ON, Canada
Does Anesthesia influence Cancer recurrence? Dr Ian McConachie FRCA FRCPC London, ON, Canada Why did my cancer come back? Inadequate resection Micro metastases Lymph spread Tumour biology Immune system
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationInternational Journal of Drug Delivery 5 (2013) Original Research Article
International Journal of Drug Delivery 5 (2013) 239-244 http://www.arjournals.org/index.php/ijdd/index Original Research Article ISSN: 0975-0215 Comparative study of duration of analgesia with epidural
More informationMultimodal perioperative pain management protocols
Multimodal perioperative pain management protocols Nader M. Hebela, MD كليفالند كلينك أبوظبي Dhabi Cleveland Clinic Abu معهد األعصاب Institute Neurological slide count: 30 January 2016 title slide explained
More informationReply to the Joint Editors-in-Chief Request for Determination Regarding Papers Published by Dr. Yoshitaka Fujii, dated April 9, 2012
Reply to the Joint Editors-in-Chief Request for Determination Regarding Papers Published by Dr. Yoshitaka Fujii, dated April 9, 2012 December 26, 2012 Research Integration Committee, University of Tsukuba
More informationOAA Survey 156: Current prescribing practices for post-operative analgesia following emergency and elective LSCS
OAA Survey 56: Current prescribing practices for post-operative analgesia following emergency and elective LSCS Janis M Ferns, Jennifer Lambert, Dharshini Radhakrishnan 2. Specialty Trainee, Barts and
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationEUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC1
PREVENTING PAIN IN NEUROSURGICAL PATIENTS EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 07RC1 SABINE HIMMELSEHER, EBERHARD F. KOCHS Department of Anaesthesiology Technical University Munich
More informationRegional Anaesthesia for Children
Regional Anaesthesia for Children Indispensable! but also safe? PD Dr. med. Jacqueline Mauch Outline Significance of regional anaesthesia in paediatric surgery Risks and complications of regional anaesthesia
More informationREGIONAL/LOCAL ANESTHESIA and OBESITY
REGIONAL/LOCAL ANESTHESIA and OBESITY Jay B. Brodsky, MD Stanford University School of Medicine Jbrodsky@stanford.edu Potential Advantages Regional compared to General Anesthesia Minimal intra-operative
More informationAnesthesie voor ambulante chirurgie
Anesthesie voor ambulante chirurgie Januari 2018 CDZ UZ Gent Coppens M Postoperativesymptoms 30 25 28 24 20 15 12 11 10 5 7 5 0 sore throat pain headache drowsiness PONV fever Chung F, Un V, Su J. Postoperative
More informationPostoperative pain management: Analgesics, algorithms and patient activation
Postoperative pain management: Analgesics, algorithms and patient activation Alfred Deakin Prof. Mari Botti Deakin University/Epworth HealthCare Victorian Perioperative Nurses Group 60 th State Conference,
More informationNon-Narcotic Pain Management Strategies in Post-Operative Patients
Non-Narcotic Pain Management Strategies in Post-Operative Patients Danielle Tompkins, PharmD University of Illinois at Chicago, College of Pharmacy PGY2 Critical Care Pharmacy Resident 1 Conflicts of Interest
More informationReversing the Opioid Epidemic: Pain & Symptom Management Inpatient Considerations and Peri operative Multi Modal Analgesia
Reversing the Opioid Epidemic: Pain & Symptom Management Inpatient Considerations and Peri operative Multi Modal Analgesia Aaron Wood 25 July 2018 Disclosures No Financial Interests Gratitude Feedback
More informationAcute Postoperative Pain. David Radvinsky, MD March 24, 2016
Acute Postoperative Pain David Radvinsky, MD March 24, 2016 Objectives 1. Discuss the multimodal approach to pain management and discuss the various classes of drugs based on receptor mechanism. 2. Give
More informationINTRA-ARTICULAR ANALGESIA WITH KETAMINE AND TRAMADOL; THE EFFECT OF THE TYPE OF SURGERY.
61 INTRA-ARTICULAR ANALGESIA WITH KETAMINE AND TRAMADOL; THE EFFECT OF THE TYPE OF SURGERY. Ashraf A Hassan, MD*, Mohamed M Khalil, MD** *Assistant professor, ** Lecturer, Anaesthesia and surgical intensive
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. COMPARATIVE STUDY OF CENTRAL VENOUS CANNULATION USING ULTRASOUND GUIDANCE VERSUS LANDMARK TECHNIQUE IN PAEDIATRIC CARDIAC PATIENT. 2. TO EVALUATE THE ABILITY OF SVV OBTAINED BY VIGILEO-FLO TRAC
More information* id of corresponding author- Received: 12/12/2016 Revised: 15/02/2017 Accepted: 21/02/2017 ABSTRACT
International Journal of Medical Science and Education An official Publication of Association for Scientific and Medical Education (ASME) Original research Article ROPIVACAINE AND ROPIVACAINE WITH CLONIDINE
More informationTHE EFFECT OF ILIOINGUINAL-ILIOHYPOGASTRIC BLOCK WITH OR WITHOUT INTRA- VENOUS PARACETAMOL FOR PAIN RELIEF AFTER CAESAREAN DELIVERY
Acta Medica Mediterranea, 2014, 30: 1183 THE EFFECT OF ILIOINGUINAL-ILIOHYPOGASTRIC BLOCK WITH OR WITHOUT INTRA- VENOUS PARACETAMOL FOR PAIN RELIEF AFTER CAESAREAN DELIVERY ALI PEKMEZCI 1, MEHMET CESUR
More informationCOMPARISON OF EPIDURAL BUTORPHANOL VERSUS EPIDURAL MORPHINE IN POSTOPERATIVE PAIN RELIEF
COMPARISON OF EPIDURAL BUTORPHANOL VERSUS EPIDURAL MORPHINE IN POSTOPERATIVE PAIN RELIEF Geeta P. Parikh *, Shah Veena R **, Kalpana Vora ***, Beena Parikh *** and Anish Joshi **** Abstract Introduction:
More informationMerja Kokki MD, PhD Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, School of Medicine, University of Eastern Finland
Long-acting opioids in obstetric analgesia and the newborn Merja Kokki MD, PhD Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, School of Medicine, University of Eastern Finland
More informationSpinal anesthesia without hypotension a myth or reality?
Spinal anesthesia without hypotension a myth or reality? Peter Poredoš, MD, PhD, DESA peter.poredos@kclj.si University Medical Centre Ljubljana, Slovenia Department for Anesthesiology and Intensive Care
More informationMitra et al. Sri Lankan Journal of Anaesthesiology: 23(2):61-65(2015) DOI: /slja.v23i2.8068
DOI: 10.4038/slja.v23i2.8068 Evaluation of analgesic efficacy of the combination of fentanyl with low dose bupivacaine vs ropivacaine using patient controlled epidural analgesia for control of labour pain-
More information11/2/2017. Background. Background. Role of On-Q Marcaine Infusion Pump in Reducing Post-operative Narcotic use in Cesarean Delivery
Role of On-Q Marcaine Infusion Pump in Reducing Post-operative Narcotic use in Cesarean Delivery Quinn Collins, UDSN Melanie Chichester, BSN, RNC-OB, CPLC Lynn Bayne, RN, PhD, NNP-BC Background Pain is
More informationAyman Abd Al-maksoud Yousef 1*, Ashraf Mohamed Atef 2 and Waleed Mohamed Awais 2
Yousef et al. BMC Anesthesiology (2015) 15:146 DOI 10.1186/s12871-015-0126-5 RESEARCH ARTICLE Comparison of fentanyl versus meperidine as supplements to epidural clonidinebupivacaine in patients with lower
More information