Epidural analgesia for the treatment of multiple ribfractures

Summary Epidural analgesia can be the choice of therapy for all patients with ribfractures and only minor coexisting injuries who are conscious and able to cooperate. In these cases we believe that EA is equivalent or even better than artificial ventilation with all its problems. Generally these patients are far easier to handle and one needs less nursing staff. The dignity of the patients can be maintained and the convalescent time in the intensive care unit is shorter. The criteria for the treatment and for measuring the progress of the patients with multiple ribfractures are discussed     

Epidural opioid analgesia

Epidural opioid analgesia has become an important therapeutic technique in the management of acute pain and has been demonstrated to be superior or equal to other parenteral opioid techniques (intramuscular, intravenous, PCA) with less associated sedation and significantly smaller doses of drugs. Beneficial therapeutic effects of epidural opioids as a result of improved analgesia include improvement in pulmonary function, modification of the endocrine-metabolic stress response, improvement in time to ambulation, decreased morbidity, and shorter hospital stay. The epidural administration of opioids is associated with potential side effects and complications, the most serious potential side effect being that of respiratory depression. This, as well as most of the other potential medication-related side effects associated with epidural opioid analgesia, is for the most part also associated with opioid analgesia provided by other routes of administration. These potential problems either occur rarely, or are controllable or preventable with appropriate patient selection and management. The potential benefits to the critical care patient as a result of the superior analgesia and reduced systemic effects associated with epidural opioid analgesia represent distinct medical and economic advantages, compared to conventional analgesic techniques.     

Epidural analgesia management

Epidural analgesia can provide excellent pain relief for patients. Nurses must have a knowledge of its application and possible adverse effects so as to provide high-quality care. Epidural analgesia may be delivered as a continuous infusion or a bolus injection. Opioids and local anaesthetics are the main drugs used. Close monitoring of the patient is vital to detect any adverse effects.     

Epidural analgesia and labor

Whilst women vary in their needs and desire for analgesia in labor it must be acknowledged that neuraxial analgesia is the only technique that can completely relieve the pain of labor. However the technique is not without its own inherent complications, both for the mother and for the process of labor and delivery. In this article the techniques for establishing and maintaining neuraxial analgesia in labor are discussed and the advantages and disadvantages of neuraxial analgesia in labor are explored.     

Epidural analgesia. Your role

For postoperative pain, epidural analgesia may be the most effective medicine. But there are a few things nurses need to know about managing the patient, including the early warning signs of complications and what to do--and what not to do--if they occur.     

Continuous epidural anesthesia in patients after surgical treatment for scoliosis

Analgesia after major spinal orthopedic surgery is a problem to be solved. The authors' original procedure for using continuous epidural anesthesia following scoliosis surgery is an effective mode of upgrading the quality of analgesia within the first 24 hours and diminishing postoperative stress. A visual analogue scale was used to evaluate the efficiency of the procedure. The levels of stress hormones (cortisol, T3, and T4) were measured.     

Internal fixation of the spine in the surgical treatment of scoliosis

Progressive idiopathic scoliosis, despite the good effects of treatment by kinesitherapy and corrective corsets, continues to pose a complicated problem in planning surgical procedure. On the one hand, the steady growth and improvement of systems for three-plane correction and fixation of scoliosis improves the radiological and clinical outcome; on the other hand, three arises the necessity to choose the surgical procedure and system of implants appropriate for the given type, localization, and angular dimensions of the curvature. The problems faced by the operating surgeon include not only making the right choice of implants, but also arranging the transpedicular screws and hooks at the proper strategic points along the curvature of the spine.
On the basis of clinical material from 200 patients surgically treated for idiopathic scoliosis, the authors present surgical solutions and analyze various implant systems (CD-HORIZON, DERO, STRYKER), made of steel or titanium, for three-plane correction and fixation of the spine. Attention is called to the application in the lumbar spine of transpedicular screws, which improve the correction and fixation of the spine and reduce the amount of instrumentation needed, while assuring the essential horizontal arrangement of the lower lumbar vertebrae.
The authors' own experience shows that modern systems for three-plane correction and fixation of the spine in scoliosis exceeding 750, despite spondylodesis, do not assure the proper correction and biomechanical value, in comparison to the Wisconsin method, which combines BW distraction with Luque intersegmentary fixation.     

Epidural analgesia for postoperative orthopaedic pain

It is well known that traditional postoperative pain management techniques often fail to relieve pain in nearly 50% of postoperative patients. The etiology of poor pain management is rooted in the fears of addiction, overmedication, and the time associated with obtaining controlled substances and administering them to patients. Patients being treated with neuroaxial analgesia (epidural and intrathecal drug administration) are appearing more frequently on orthopaedic nursing units. It is therefore imperative that nurses are familiar with the care of patients with epidural catheters. This article discusses the relevant anatomy, physiology, pharmacology, contraindications, and complications associated with neuroaxial analgesia, with special emphasis placed on the orthopaedic patient.     

Epidural analgesia in the treatment of the pain syndrome in degenerative dystrophic disorders of the lumbar spine

Epidural analgesia (EA) with dicaine and morphine has been compared in 34 patients with pain syndrome caused by degenerative dystrophy of lumbar vertebrae. The advantages of EA with dicaine have been observed. 35.3% of patients have been subject to surgery. In the rest of patients pain syndrome was relieved. Radionuclide epidurography has shown that the volume of the anesthetic solution injected should not exceed 10 ml.     

退变性腰椎侧凸患者行后路手术的护理

目的 探讨对进行后路固定融合的退变性腰椎侧凸患者的积极有效的护理措施,以提高手术疗效,减少并发症发生率.方法 通过对34例退变性腰椎侧凸手术患者进行详细的术前心理评估与护理、术前训练以及术后生命体征的观察,通过各种措施预防早期并发症,进行积极康复训练等,观察良好的临床护理对促进患者康复的作用.结果 34例退变性腰椎侧凸患者术后均恢复良好,未出现因护理不当而导致的各种并发症,取得了满意效果.结论 提高对退变性腰椎侧凸的护理水平,对于提高临床疗效,减少术后并发症发生率,促进患者康复具有重要的意义.