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  • Print publication year: 2009
  • Online publication date: October 2009

15 - Clinical Applications of Epidural Analgesia

from SECTION II - Clinical Analgesia


1. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA, Wu CL. Efficacy of postoperative epidural analgesia: a metanalysis. JAMA. 2003;290:2455–2463.
2. Liu SS, Carpenter RL, Mackey DC, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology. 1995d;83:757–765.
3. Richman JM, Wu CL. (2005). Epidural analgesia for postoperative pain. Anesthesiol Clin North Am. 2005;23:125–140.
4. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000;321:1493.
5. Wu CL, Fleischer LA. (2000a). Outcomes research in regional anesthesia and analgesia. Anesth Analg. 2000a;91:1232–1342.
6. Brodner G, Mertes N, Buerkle H, Marcus MA, Van Aken H. Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients. Eur J Anaesthsiol. 2000;17:566–675.
7. Liu SS, Bernards CM. Exploring the epidural trail. Reg Anesth Pain Med. 2002;27:122–124.
8. Chisakuta AM, George KA, Hawthorne CT. Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery: a comparison of thoracic and lumbar routes. Anaesthesia. 1995;50:72–75.
9. Liu SS, Allen HW, Olsson GL. Patient controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1,030 surgical patients. Anesthesiology. 1998;88:688–695.
10. Magnusdottir H, Kirno K, Ricksten SE, Elam M. High thoracic epidural anesthesia does not inhibit sympathetic nerve activity in the lower extremities. Anesthesiology. 1999;91:1299–1304.
11. Broekema AA, Gielen MJ, Hennis PJ. Postoperative analgesia with continuous epidural sufentanil and bupivacaine: a prospective study in 614 patients. Anesth Analg. 1996;82:754–759.
12. Kahn L, Baxter FJ, Dauphin A, et al. A comparison of thoracic and lumbar epidural techniques for post-thoracoabdominal esophagectomy analgesia. Can J Anaesth. 1999;46:415–422.
13. Ready LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med. 1999;24:499–505.
14. Mogensen T, Eliasen K, Ejlersen E, Vegger P, Nielsen IK, Kehlet H. Epidural clonidine enhances postoperative analgesia from a combined low-dose epidural bupivacaine and morphine regimen. Anesth Analg. 1992;75:607–610.
15. Paech MJ, Pavy TJ, Orlikowski CE, Lim W, Evans SF. Postoperative epidural infusion: a randomized, double-blind, dose-finding trial of clonidine in combination with bupivacaine and fentanyl. Anesth Analg. 1997;84:1323–1328.
16. Chia YY, Liu K, Liu YC, Chang HC. Adding ketamine in a multimodal patient-controlled epidural regimen reduces postoperative pain and analgesic consumption. Anesth Analg. 1998;86:1245–1249.
17. Marcus MA, Vertommen JD, Van Aken H, Gogarten W, Buerkle H. The effects of adding isoproterenol to 0.125 % bupivacaine on the quality of epidural analgesia in laboring parturients. Anesth Analg. 1998;86:749–752.
18. Choe H, Kim JS, Ko SH, Kim DC, Han YJ, Song HS. Epidural verapamil reduces analgesic consumption after lower abdominal surgery. Anesth Analg. 1998;86:786–790.
19. Yaksh TL. Epidural ketamine: a useful, mechanistically novel adjuvant for epidural morphine? Reg Anesth. 1996;21:508–513.
20. Wu CT, Yeh CC, Yu JC, et al. Pre-incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre-emptive analgesia for upper abdominal surgery. Acta Anaesthesiol Scand. 2000;44:63–68.
21. Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative epidural analgesia. Br J Anaesth. 2001;87:47–61.
22. Fink BR, Walker S. Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. Anesth Analg. 1989;69:768.
23. Kerber CW, Newton TH. The macro and microvasculature of the dura mater. Neuroradiology. 1973;6:175–179.
24. Kozody R, Palahniuk RJ, Wade JG, Cumming MO, Pucci WR. The effect of subarachnoid epinephrine and phenylephrine on spinal cord blood flow. Can Anaesth Soc J. 1984;31:503–508.
25. Bernards CM. Understanding the physiology and pharmacology of epidural and intrathecal opioids. Best Pract Res Clin Anaesthesiol. 2002;16:489–505.
26. Vandenabeele F, Creemers J, Lambrichts I. Ultrastructure of the human spinal arachnoid mater and dura mater. J Anat. 1996;189:417–430.
27. Bernards CM, Hill HF. Morphine and alfentanil permeability through the spinal dura, arachnoid and pia mater of dogs and monkeys. Anesthesiology. 1990;73:1214–1219.
28. DiChiro GD, Hammock MK, Bleyer WA. Spinal descent of cerebrospinal fluid in man. Neurology. 1976;26:1–8.
29. Nordberg G, Hedner T, Mellstrand T, Dahlström B. Pharmacokinetic aspects of intrathecal morphine analgesia. Anesthesiology. 1984;60:448–454.
30. Herz A, Teschemacher H. Activities and sites of antinociceptive action of morphine-like analgesics and kinetics of distribution following intravenous, intracerebral and intraventricular application. In: Simmonds A, ed. Advances in Drug Research. London: Academic Press;1971:79–117.
31. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000;92:739–753.
32. El-Baz NMI, Faber LP, Jensik RJ. Continuous epidural infusion of morphine for treatment of pain after thoracic surgery: a new technique. Anesth Analg. 1984;63:757–764.
33. Reisine T, Pasternak G. Opioid analgesics and antagonists. In: LS Goodman LS, Gilman A, eds. The Pharmacologic Basis of Therapeutics. 9th ed. New York, NY: Macmillan; 1997:494–534.
34. Grass JA. Epidural analgesia. In: Grass JA, ed. Problems in Anesthesia. Vol. 10, ed. Philadelphia, PA: Lippincott-Raven; 1998:445.
35. Kilbride MJ, Senagore AJ, Mazier WP, Ferguson C, Ufkes T. Epidural analgesia. Surg Gynecol Obstet. 1992;174:137–140.
36. Weller R, Rosenblum M, Conard P, Gross JB. Comparison of epidural and patient-controlled intravenous morphine following joint replacement surgery. Can J Anaesth. 1991;38:582–586.
37. Liu S, Carpenter RL, Mulroy MF, et al. Intravenous versus epidural administration of hydromorphone: effects on analgesia and recovery after radical retropubic prostatectomy. Anesthesiology. 1995b;82:682–688.
38. Halpern SH, Arellano R, Preston R, et al. Epidural morphine versus hydromorphone in post-caesarean section patients. Can J Anaesth. 1996;43:595–598.
39. Harrison DM, Sinatra R, Morgese L. Epidural narcotic and patient controlled analgesia for post-cesarean section pain relief. Anesthesiology. 1988;68:454–457.
40. White PW. Use of patient-controlled analgesia for management of acute pain. JAMA. 1998;259:243–247.
41. Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg. 2003;97:1428–1438.
42. Miguel R, Barlow I, Morrell M, Scharf J, Sanusi D, Fu E. A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions. Anesthesiology. 1994;81:346–352.
43. Coda BA, Brown MC, Schaffer RL, Donaldson G, Shen DD. A pharmacokinetic approach to resolving spinal and systemic contributions to epidural alfentanil analgesia and side-effects. Pain. 1995;62:329–337.
44. Viscusi E. Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg. 2005;101:S23–S29.
45. Fotiadis RJ, Bavdie S, Weston MD, Allen-Mersh TG. Epidural analgesia in gastrointestinal surgery. Br J Surg. 2004;91:828–841.
46. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology. 1995c;82:1474–1506.
47. Kaba A, Laurent SR, Detroz BJ, et al. Intravenous Lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007;106:11–18.
48. Hollmann MW, Wieczorek KS, Smart M, Durieux ME. Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery. Reg Anesth Pain Med. 2001;26:215–222.
49. Conacher ID, Paes ML, Jacobseon L, Phillips PD, Heaviside DW. Epidural analgesia following thoracic surgery: a review of two year's experience. Anaesthesia. 1983;38:546–551.
50. Ross RA, Clarke JE, Armitage EN. Postoperative pain prevention by continuous epidural infusion: a study of the clinical effects and the plasma concentrations obtained. Anaesthesia. 1980;35;663–668.
51. Mitchell RW, Scott DB, Holmquist E, Lamont M. Continuous extradural infusion of 0.125% bupivacaine for pain relief after lower abdominal surgery. Br J Anaesth. 1988;60:851–853.
52. Schug SA, Scott DA, Payne J, Mooney PH, Hagglof B. Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery. Br J Anaesth. 1996;76:487–491.
53. Etches RC, Writer WD, Ansley D, et al. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominalsurgery. Anesth Analg. 1997;84:784–790.
54. Stevens RA, Bray JG, Artuso JD, Kao TC, Spitzer L. Differential epidural block. Reg Anesth. 1992;17:22–25.
55. White JL, Stevens RA, Beardsley D, Teague PJ, Kao TC. Differential epidural block: does the choice of local anesthetic matter? Reg Anesth. 1994;19:335–338.
56. Zaric D, Nydahl PA, Philipson L, Samuelsson L, Heierson A, Axelsson K. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) and 0.25% bupivacaine on sensory and motor block in volunteers: a double-blind study. Reg Anesth. 1996;21:14–25.
57. Jorgensen H, Wetterslev J, Moiniche S, Dahl JB. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev. 2000;CD001893.
58. Kopacz DJ, Sharrock NE, Allen HW. A comparison of levobupivacaine 0.125%, fentanyl 4microg/ml, or their combination for patient-controlled epidural analgesia after major orthopedic surgery. Anesth Analg. 1999;89:1497–1503.
59. Hjortso NC, Lund C, Mogensen T, Bigler D, Kehlet H. Epidural morphine improves pain relief and maintains sensory analgesia during continuous epidural bupivacaine after abdominal surgery. Anesth Analg. 1989;65:1033–1036.
60. Scott NB, Mogensen T, Bigler D, Lund C, Kehlet H. Continuous thoracic extradural 0.5% bupivacaine with or without morphine: effect on quality of blockade, lung function and the surgical stress response. Br J Anaesth. 1989;62:253–257.
61. Dahl JB, Rosenberg J, Hansen BL, Hjortso NC, Kehlet H. Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery. Anesth Analg. 1992;74:362–365.
62. Crews JC, Hord AH, Denson DD, Schatzman C. A comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery. Anesth Analg. 1999;89:1504–1509.
63. Lowson SM, Alexander JI, Black AMS, Bambridge AD. Epidural diamorphine infusions with and without 0.167% bupivacaine for postoperative analgesia. Eur J Anaesthesiol. 1994;11:345–352.
64. Etches RC, Gammer TL, Cornish R. Patient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine. Anesth Analg. 1996;83:81–86.
65. Paech MJ, Westmore MD. Postoperative epidural fentanyl infusion-is the addition of 0.1% bupivacaine of benefit? Anaesth Intensive Care. 1994;22:9–14.
66. Torda TA, Hann P, Mills G, De Leon G, Penman D. Comparison of extradural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures for pain relief after abdominal surgery. Br J Anaesth. 1995;74:35–40.
67. Mahon SV, Berry PD, Jackson M, Russell GN, Pennefather SH. Thoracic epidural infusions for post-thoracotomy pain: a comparison of fentanyl-bupivacaine mixtures vs. fentanyl alone. Anaesthesia. 1999;54:641–646.
68. Scott DA, Blake D, Buckland M, et al. A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 μg/ml fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. Anesth Analg. 1999;88:857–864.
69. Mourisse J, Hasenbos MA, Gielen MJ, Moll JE, Cromheecke GJ. Epidural bupivacaine, sufentanil or the combination for post-thoracotomy pain. Acta Anaesthesiol Scand. 1992:36:70–74.
70. Wieblack A, Brodner G, Van Aken H. The effects of adding sufentanil to bupivacaine postoperative patient-controlled epidural analgesia. Anesth Analg. 1997;85:124–129.
71. Kampe S, Weigand C, Kaufmann J, Klimek M, Konig DP, Lynch J. Postoperative analgesia with no motor block by continuous epidural infusion of ropivacaine 0.1% and sufentanil after total hip replacement. Anesth Analg. 1999;89:395–398.
72. Sinatra RS, Eige S, Chung JH, et al. Continuous epidural infusion of 0.05% bupivacaine plus hydromorphone for labor analgesia: an observational assessment in 1830 parturients. Anesth Analg. 2002;94:1310–1311.
73. Liu S, Angel JM, Owens, BD, Carpenter RL, Isabel L. Effects of epidural bupivacaine after thoracotomy. Reg Anesth. 1995a;20:303–310.
74. Liu SS, Moore JM, Luo AM, Trautman WJ, Carpenter RL. Comparison of three solutions of ropivacaine/fentanyl for patient controlled epidural analgesia. Anesthesiology. 1999;90:727–733.
75. Steinberg RB, Liu SS, Wu CL, et al. Comparison of ropivacaine/fentanyl PCEA vs IV PCA for perioperative analgesia and recovery after open colon surgery. J Clin Anesth. 2002;14:571–577.
76. Niemi G, Breivik H. Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery. A randomized, double-blind, cross-over study with and without adrenaline. Acta Anaesthesiol Scand. 1998;42:897–909.
77. Aromaa U, Lahdensuu M, Cozanitis DA. Severe complications associated with epidural and spinal anaesthesias in Finland 1987–1993: a study based on patient insurance claims. Acta Anaesthesiol Scand. 1997;41:445–452.
78. Kane RE. Neurologic deficit following epidural or spinal anesthesia. Anesth Analg. 1981;60:150–161.
79. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia; results of a prospective survey in France. Anesthesiology. 1997;87:479–486.
80. Schwander D, Bachmann F. Heparin and spinal or epidural anesthesia: decision analysis. Ann Fr Anesth Reanim. 1991;10:284–296.
81. Wang CY, Ong GS. Severe bronchospasm during epidural anaesthesia. Anaesthesia. 1993;48:514–515.