Document Detail


Epidural analgesia decreases intraabdominal pressure in postoperative patients with primary intra-abdominal hypertension.
MedLine Citation:
PMID:  18575048     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Surgical decompression is a lifesaving procedure in patients with severe intraabdominal hypertension. However, it involves subsequent management of an open abdomen. Therefore, it is not recommended for moderate intra-abdominal hypertension. Our literature search did not show any studies relating the efficacy of epidural analgesia in decreasing elevated intraabdominal pressure (IAP) in critically-ill surgical patients with primary intra-abdominal hypertension.
MATERIAL AND METHODS: Through a blinded prospective study, we investigated postoperative critically-ill surgical and trauma patients with primary intra-abdominal hypertension, who received postoperative thoracic epidural analgesia (n = 58) or intravenous opioid analgesia (n = 130). Patients in the epidural group received ropivacaine 0.2% 10 ml, followed by an infusion of 5 ml/h for 96 hours. Patients in the opioid group could receive morphine hydrochloride (0.1 mg/kg IV for every 4-6 hours as needed) with or without ketorolac trometamol (up to 90 mg/day IV). IAP was measured transvesically, for every 6 hours. Additionally, measurements immediately before and 1 hour after the initiation of epidural analgesia were taken. Abdominal Perfusion Pressure (APP) was calculated for each IAP measurement as APP = MAP - IAP where MAP is the mean arterial pressure.
RESULTS: In the epidural group we found a consistent decrease in IAP from 16.82 +/- 4.56 to 6.30 +/- 3.11 mmHg and an increase in APP from 60.26 +/- 21.893 to 76.10 +/- 17.54 mmHg between baseline values until the second day of epidural analgesia, which remained stable afterwards. There were no significant differences of IAP and APP in the opioid group.
CONCLUSION: Continuous thoracic epidural analgesia decreases IAP and improves APP without haemodynamic compromise in postoperative critically-ill patients with primary intra-abdominal hypertension.
Authors:
R V Hakobyan; G G Mkhoyan
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Acta clinica Belgica     Volume:  63     ISSN:  1784-3286     ISO Abbreviation:  Acta Clin Belg     Publication Date:    2008 Mar-Apr
Date Detail:
Created Date:  2008-06-25     Completed Date:  2008-09-04     Revised Date:  2014-03-18    
Medline Journal Info:
Nlm Unique ID:  0370306     Medline TA:  Acta Clin Belg     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  86-92     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Abdomen / physiopathology*
Analgesia, Epidural / methods*
Compartment Syndromes / complications,  physiopathology,  therapy*
Critical Illness / therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pain Measurement
Pain, Postoperative / etiology,  physiopathology,  therapy*
Pressure
Prospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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