Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
-
Acta Anaesthesiol Taiwan · Sep 2006
Case ReportsEpidural analgesia masked the diagnosis of femoral neuropathy following renal transplantation.
Kidney transplantation related femoral neuropathy can mimic epidural catheter related radiculopathy in clinical presentation. Anesthesiologists should keep this possibility in mind when performing epidural anesthesia or analgesia for kidney transplantation. We present a 52-year-old male who after undergoing cadaveric kidney transplantation under general anesthesia in combination with epidural analgesia made possible by catheterization via T11-12 interspace for reinforcement of anesthesia and for postoperative patient-controlled epidural analgesia (PCEA) sustained sensory disturbance and muscle weakness of the lower limbs. ⋯ The final diagnosis turned out to be surgical procedure related femoral neuropathy. We believe this is the first instance ever reported about the dilemma in making a predicative diagnosis from two conditions near akin in kidney transplantation. Accurate diagnosis made through serial image and electrophysiologic studies are essential to appropriate management.
-
Acta Anaesthesiol Taiwan · Sep 2006
Case ReportsCombined subdural and epidural block in a case of epidural catheterization for postoperative analgesia.
We report a case of unusual block caused by postoperative epidural analgesia for laparotomy in a gynecologic patient in consequence of inadvertent epidural catheterization. The clinical manifestation included agitation, spotty distribution of analgesia, wide spread of sensory block and loss of motor power. The radiological findings suggested a multicompartmental block with the anchorage of the catheter tip stretching over the epidural and subdural spaces. The default of catheter position was not detected during routine test dose procedure.
-
Acta Anaesthesiol Taiwan · Sep 2006
Correlations between patient-controlled epidural analgesia requirements and individual characteristics among gynecologic patients.
Patient-controlled epidural analgesia (PCEA) has been used widely to relieve postoperative pain. Although many studies have demonstrated the safety and effectiveness of PCEA, the relationship between patients' characteristics and requirements of PCEA has not been investigated yet. We conducted this retrospective study to explore the correlations between total PCEA demand and patients' characteristics. ⋯ Disease patterns, BMI and age are associated with total PCEA requirements. Gynecologic patients receiving procedures for malignant diseases consumed more PCEA solution than benign cases. Height is not associated with total PCEA demand. There is a close correlation between BMI and PCEA consumption but age is a negative correlate.
-
Acta Anaesthesiol Taiwan · Sep 2006
Randomized Controlled Trial Comparative StudyComparison of intravenous patient-controlled analgesia with buprenorphine versus morphine after lumbar spinal fusion--a prospective randomized clinical trial.
Opioid-based patient-controlled analgesia (PCA) has been used widely and effectively after spine surgery. The untoward effects of intravenous opioids could vary with the drug and dose applied. Buprenorphine, a partial opioid agonist, might be devoid of the adverse effects which the traditional opioids have. We conducted this prospective randomized clinical trial to evaluate the efficacy and safety of buprenorphine for intravenous PCA after spine surgery. ⋯ Both buprenorphine and morphine by intravenous PCA provided adequate pain relief after posterior lumbar spinal fusion. The incidences of side effects were similar in both groups except for pruritus which did not appear in buprenorphine group. Buprenorphine was as efficient as morphine and safe for intravenous PCA after spine surgery.