Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
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Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
SECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2or epidural anesthesia and analgesia have expanded significantly over the past several decades Epidural analgesia is often used to supplement general anesthesia (GA) for surgical procedures in patients of all ages with moderate-to-severe comorbid disease; provide analgesia m the intraoperative, post Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2operative, peripartum, and end-of-life settings; and can be used as the primary anesthetic for surgeries from the mediastinum to the lower extremitiesEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
. In addition, epidural techniques are used increasingly for diagnostic procedures, acute pain therapy, and management of chronic pain. Epidural blockSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2the morbidity and mortality associated with major surgery.This chapter covers the essentials of epidural anesthesia and analgesia. After a brief history' of the transformation from single-shot to continuous epidural catheter techniques. It reviews 11) indications for and contraindications to epidura Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2l blockade; (2) basic anatomic considerations for epidural placement. (3) physiologic effects of epidural blockade; (4) pharmacology of drugs used forEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
epidural anesthesia and analgesia; (5) techniques for successful epidural placement; and <6) major and minor complications associated with epidural bSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2mtbon -ftOraJd !tk» to think XbchHl A Xlikai','. MB. BAO. ChB. ix hit luip 'Atfh ths tiblM Uti figumanatomy, the traditional epinephrine test dose, methods Used to identify- the epidural space, and whether particular clinical outcomes may be improved with epidural techniques when compared to GA. Mot Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2e detailed information about local anesthetics (LAs), the mechanism of neuraxial blockade, the combined spinal-epidural (CSE) technique, obstetric aneEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
sthesia, and complications of central neuraxral blockade is provided elsewhere in this textbook.BRIEF HISTORYThe neurologist J. Leonard Coming proposeSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2 term iplnal anafhtito. he may unknowingly have been investigating the epidural space. The French physicians Jean Sicard and Fernand Cathehn are credited with the first intentional administration of epidural anesthesia. At the turn of the 20th century, they independently introduced single-shot cauda Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2l blocks with cocaine for neurologic and genitourinary procedures, respectively.1 Nineteen years later, the Spanish surgeon Fidel Pages Miravé describEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
ed a single-shot thoracolumbar approach to ‘peridural" anesthesia, identifying tire epidural space through subtle tactile distinctions in (he ligamentSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2stance (LOR) technique to identify- the epidural space.5 Contemporaneously. the Argentine surgeon Alberto Gutierrez described the ‘Sign of the drop" for identification of the epidural space.EpldA number of innovations by Eugene Aburel. Robert Hingson. Waldo Edwards, and James Southworth, among other Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2s. attempted to prolong the single-shot epidural technique. However. Cuban anesthesiologist Manual Martinez Curbelo IS credited with adapting Edward TEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
uohy's continuous subarachnoid technique for the epidural space in 1947. His efforts were facilitated by an extensive knowledge of anatomy, a first-haSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2ich curved as they exited the tip of the needle.4 Several modifications of the Tuohy needle, itself a modification of the Huber needle, have since emerged.The epidural catheter has also evolved from its origins as a modified ureteral catheter. Several manufacturers currently use nylon blends to prod Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2uce thin, kink-resistant catheters of appropriate tensile strength and stiffness. The wire-reinforced catheter represents the most recent technologicaEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
l advance in epidural catheter design. The addition of a circumferential stainless steel coil within a nylon or polyurethane catheter confers greater SECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2aresthesias.INDICATIONSTills section presents common and controversial indications for the use of lumbar and thoracic epidural blockade in lower extremity, genitourinary, vascular, gynecologic, colorectal, and cardiothoracic surgery. It also reviews less common and novel indications for epidural ane Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2sthesia and analgesia, including for the treatment of patients with sepsis and uncommon medical disorders ( 1 able 24 1). The use of neuraxial blockadEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
e for obstetric patients, pediatnc surgery, and chronic pain and in the ambulatory setting is covered in greater detail elsewhere in this textbook.LumSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2omen but is increasingly being used as the sole anesthetic or as a complement to GA for a greater diversity of procedures. This section examines several common indications for lumbar epidural blockade, including lower extremity orthopedic surgery, infrainguinal vascular procedures, and genitourinary Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2 and vaginal gynecologic surgeries. When applicable. It reviews the benefits and drawbacks of the use of neuraxial techniques versus GA for specific pEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
rocedures.Lower Extremity Major Orthopedic SurgeryBoth perioperative anticoagulant thromboprophylaxis and the increasing reliance on peripheral nene bSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2esthetic or as a supplement to either GA or peripheral techniques is still widely used for major orthopedic surgeries of the lower extremities. The effective postoperative pain controlTABLE 24-1. Examples of applications for epidural blockade.1 SpecialtySurgical Procedure1Orthopedic surgeryMajor hip Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2 and knee surgery, pelvic fracturesObstetric surgeryCesarean delivery, labor analgesiaGynecologic surgeryHysterectomy, pelvic floor proceduresGeneralEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
surgeryBreast, hepatic, gastric colonic surgeryPediatric surgeryInguinal hernia repair, orthopedic surgeryAmbulatory surgeryFoot, knee, hip, anorectalSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2cystectomy. lithotripsy, nephrectomyVascular surgeryAmputation of lower extremity, revascularization proceduresMedical conditionsAutonomic hyperreflexia, myasthenia gravis. pheochromocytoma, known or suspected malignant hyperthermiaCHAPTER 24provided by either peripheral or neuraxial blocks, or a co Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2mbination of the two techniques, improves patient satisfaction, permits early ambulation, accelerates functional recuperation, and may shorten hospitaEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
l stay, particularly after major knee surgery. Other potential benefits of the use of neuraxial blockade in lieu of GA include the reduced incidence oSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2 intraoperatnv blood loss and transfusion requirements' A recent meta-analysis also demonstrated a statistically significant reduction in operative time when neuraxial blockade was used in patients undergoing elective total hip replacement, although the authors did not distinguish between spinal and Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2 epidural techniques.1Major orthopedic procedures that can be performed under epidural. CSE, or integrated epidural and GA include primary hip or kneeEbook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2
arthroplasty, surgery for hip fracture, revision arthroplasty, bilateral total knee arthroplasty, acetabular bone grafting, and insertion of long-steSECTION 2Epidural AnesthesiaCHAPTER 24Epidural Anesthesia and AnalgesiaRoulhac D. Toledano and .Xiarc Van de Velde*INTRODUCTIONClinical indications to Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2 pain is slight or negligible (eg. total hip arthroplasty) or if aGọi ngay
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