tailieunhanh - Gastrointestinal Oncology - part 6

Gây tê ngoài màng cứng Đối với các thủ tục phẫu thuật lớn, ngực và bụng, gây tê ngoài màng cứng là tốt hơn trong ảnh hưởng của nó giảm đau khi so sánh với điều trị thuốc giảm đau khác. Bằng chứng từ một phân tích meta gần đây sau phẫu thuật gây tê | 206 Chapter 12 Epidural Analgesia For major thoracic and abdominal surgical procedures epidural analgesia is superior in its pain-relieving effects when compared to other analgesic therapy. Evidence from a recent meta-analysis on postoperative epidural analgesia confirms that better pain control is achieved compared to parenteral opioids regardless of the analgesic agent and level of the The optimal approaches for this technique are often debated as epidural analgesia can involve both single agent or combination therapy and delivery of agents at different levels in the epidural space. Moreover variations exist in reported failure rates and risk benefit analyses. Most often therapy with continuous infusions with or without patient-controlled epidural analgesia is associated with better pain outcomes than intermittent dosing schedules alone. Studies consistently show that combinations of an opioid and local anesthetic provide significantly greater pain relief following upper and lower abdominal surgery in contrast to single agent administration. The advantages of lipophilic opioids fentanyl and hydromorphone alone are questionable especially for pain management after upper and lower abdominal There is definitely a role for epidural analgesia following major abdominal surgery for GI malignancies. Despite the lack of randomized controlled trials to evaluate the effectiveness of catheter levels with abdominal procedures the use of thoracic epidurals remains the standard for practice. The key is concordance of anatomic site and catheter location ie thoracic dermatome incision and thoracic epidural . With opioid and local anesthetic combinations thoracic administration promotes the drug delivery of smaller doses of lipophilic agents at the same level of the incision and lessens chances for motor and sympathetic blockade from local Successful placement of thoracic catheters requires technical expertise that is often present among .