TIMOTHY J. BRENNAN PhD, MD DEPTS OF ANESTHESIA UNIVERSITY OF IOWA An Update on Thoracic Epidural Blocks ©2008 The University of Iowa Department of Anesthesia
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TIMOTHY J. BRENNAN PhD, MDDEPTS OF ANESTHESIAUNIVERSITY OF IOWA
An Update on Thoracic
Epidural Blocks ©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
THORACIC EPIDURAL ANALGESIA
Placement
Drugs for thoracic epidural analgesia
©2008 The University of Iowa Department of Anesthesia
TEA-Thoracic surgery
©2008 The University of Iowa Department of Anesthesia
TEA-Upper Abdominal surgery
Hepatic Surgery, Pancreatectomy
©2008 The University of Iowa Department of Anesthesia
TEA-Lower Abdominal surgery
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
1 cm
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
©2008 The University of Iowa Department of Anesthesia
EPIDURAL LOCAL ANESTHETICS
• Bupivacaine 0.05%-0.10%
• Ropivacaine 0.125%-0.2%
©2008 The University of Iowa Department of Anesthesia
Differential analgesic effects…. Anesth. Analg. 74:362, 1992
©2008 The University of Iowa Department of Anesthesia
Choice of epidural opioidPa
rent
eral
to E
pidu
ral R
atio
Fentanyl
Fentanyl+
Epinephrine
Hydromorphone
Morphine
©2008 The University of Iowa Department of Anesthesia
LOCALANESTHETIC
OPIOIDS ADVANTAGES/DISADVANTAGES
Bupivacaine0.125%
None opioid side effects/ aahemodynamic sideeffects
Bupivacaine0.10%
Hydromorphone5-10 mcg/ml both
Bupivacaine0.05%
Hydromorphone5-10 mcg/ml
hemodynamic andopioid side effects
Bupivacaine0.05%
Hydromorphone20 mcg/ml
None Hydromorphone40 mcg/ml
hemodynamic sideeffects opioid side effects
©2008 The University of Iowa Department of Anesthesia
ADVANTAGES OF POSTOPERATIVE EPIDURAL ANALGESIA LOCAL ANESTHETIC-OPIOID COMBINATIONS
• Reduced Pain Scores With Movement
• Earlier Return Of Bowel Function
• Reduced Pulmonary Complications
• Shorter ICU Stay
• Shorter Hospital Stay
©2008 The University of Iowa Department of Anesthesia
LIMITATIONS OF EPIDURAL ANALGESIA FOR ACUTE PAIN RELIEF
Requires hemodynamic stability
Side effects will occur
Pain is not necessarily eliminated
Non-surgical pain must be assessed
It is not without risk
©2008 The University of Iowa Department of Anesthesia
THORACIC EPIDURAL ANALGESIA
Placement
Drugs for thoracic epidural analgesia
Coagulation and thoracic epidural analgesia
©2008 The University of Iowa Department of Anesthesia
MOnday
an update on interscalene and infraclavicular blocks
an update on femoral and popliteal blocks
an update on thoracic epidural blocks
www.anesth.uiowa.edu/cabo
©2008 The University of Iowa Department of Anesthesia
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