Spinal Injections – London Spine Specialists

By Jaimig Aljorna

Spinal injections have the particularity of being both diagnostic and therapeutic. –Diagnostic because it allows discovering the cause of the pain. For instance, when an injection provides pain relief in the area that is injected, then it is the source of the problem. –Therapeutic because it can alleviate temporarily your chronic back pain. Medications In…

Spinal-general anaesthesia decreases neuroendocrine stress response in laparoscopic cholecystectomy.

By London Spine
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Spinal-general anaesthesia decreases neuroendocrine stress response in laparoscopic cholecystectomy.

J Int Med Res. 2012;40(2):657-65

Authors: Calvo-Soto P, Martínez-Contreras A, -Hernández BT, And FP, Vásquez C

Abstract
OBJECTIVE: A randomized clinical study to compare the stress response to laparoscopic cholecystectomy during spinal-general anaesthesia and epidural- general anaesthesia.
METHODS: Women undergoing elective laparoscopic chole cystectomy were assigned to receive either spinal anaesthesia (SA group; n = 12) or epidural anaesthesia (EA group; n = 12), in addition to general anaesthesia. Plasma concentrations of cortisol, adrenocorticotrophic hormone (ACTH), noradrenaline, adrenaline and total catecholamines were measured pre- and intraoperatively.
RESULTS: Intraoperative cortisol, noradrenaline and total catecholamine levels were significantly lower in the SA group compared with the EA group. When pre- and intraoperative values were compared, the SA group showed a decrease in adrenaline, noradrenaline and total catecholamine levels, and the EA group showed an increase in ACTH and noradrenaline levels.
CONCLUSIONS: The type of regional anaesthesia significantly affected the stress response: spinal anaesthesia produced a more favourable endocrine response than epidural anaesthesia. Spinal-general anaesthesia may reduce postoperative morbidity in laparoscopic cholecystectomy.

PMID: 22613427 [PubMed – indexed for MEDLINE]

Comparison of isoflurane inhalation anaesthesia, injection anaesthesia and high volume caudal epidural anaesthesia for umbilical surgery in calves; metabolic, endocrine and cardiopulmonary effects.

By London Spine
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Comparison of isoflurane inhalation anaesthesia, injection anaesthesia and high volume caudal epidural anaesthesia for umbilical surgery in calves; metabolic, endocrine and cardiopulmonary effects.

Vet Anaesth Analg. 2012 Mar;39(2):123-36

Authors: Offinger J, Meyer H, Fischer J, Kästner SB, Piechotta M, Rehage J

Abstract
OBJECTIVE: To compare three anaesthetic protocols for umbilical surgery in calves regarding adequacy of analgesia, and cardiopulmonary and hormonal responses.
STUDY DESIGN: Prospective, randomised experimental study.
ANIMALS: Thirty healthy German Holstein calves (7 female, 23 male) aged 45.9 ± 6.4 days.
METHODS: All calves underwent umbilical surgery in dorsal recumbency. The anaesthetic protocols were as follows: group INH (n = 10), induction 0.1 mg kg(-1) xylazine IM and 2.0 mg kg(-1) ketamine IV, maintenance isoflurane in oxygen; Group INJ (n = 10), induction 0.2 mg kg(-1) xylazine IM and 5.0 mg kg(-1) ketamine IV, maintenance 2.5 mg kg(-1) ketamine IV every 15 minutes or as required; group EPI (n = 10), high volume caudal epidural anaesthesia with 0.2 mg kg(-1) xylazine diluted to 0.6 mL kg(-1) with procaine 2%. All calves received peri-umbilical infiltration of procaine and pre-operative IV flunixin (2.2 mg kg(-1) ). Cardiopulmonary variables were measured at preset intervals for up to 2 hours after surgery. The endocrine stress response was determined. Intra-operative nociception was assessed using a VAS scale. Data were compared between groups using appropriate statistical tests. A value of p < 0.05 was considered significant.
RESULTS: All three protocols provided adequate anaesthesia for surgery although, as judged by the VAS scale, intra-operative response was greatest with INJ. Lowest mean cortisol levels during surgery occurred in EPI. Heart rate and cardiac output did not differ between groups, but mean arterial blood pressure, systemic vascular resistance, and partial pressure of carbon dioxide were higher and arterial pH lower in groups INH and INJ than in Group EPI. Group INJ became hypoxaemic and had a significantly greater vascular shunt than did the other groups.
CONCLUSION AND CLINICAL RELEVANCE: Groups INH and EPI both proved acceptable protocols for calves undergoing umbilical surgery, whilst INJ resulted in variable anti-nociception and in hypoxaemia. High volume caudal epidural anaesthesia provides a practical inexpensive method of anaesthesia for umbilical surgery.

PMID: 22356414 [PubMed – indexed for MEDLINE]

Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters.

By London Spine
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Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters.

Acta Anaesthesiol Scand. 2013 Feb 20;

Authors: Wink J, Wolterbeek R, Aarts LP, Koster SC, Versteegh MI, Veering BT

Abstract
BACKGROUND: Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3-T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied. METHODS: Thirty-five lung surgery patients were included in three age groups. Thirty-one patients received an epidural catheter at the T3-T4 interspace followed by an injection of 8-ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV). RESULTS: There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P < 0.001), mean arterial pressure (16.1 ± 15.6, P < 0.001), CI (0.55 ± 0.49, P < 0.001) and SV (9.6 ± 14.6, P = 0.001) decreased after TEA for the total group. Maximal reduction in heart rate after TEA was more extensive in the young age group compared with the other age groups. There was no effect of age on other cardiovascular parameters. CONCLUSION: We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.

PMID: 23421557 [PubMed – as supplied by publisher]

Regional anaesthesia in paediatric surgery: results of 2200 children.

By London Spine
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Regional anaesthesia in paediatric surgery: results of 2200 children.

J Pak Med Assoc. 2011 Aug;61(8):782-6

Authors: Beyaz SG, Tokgöz O, Tüfek A

Abstract
OBJECTIVES: To evaluate paediatric regional anaesthesia applications in 2200 children at Diyarbakir Children’s Hosptial, Turkey.
METHODS: This is a cross-sectional study done from January 2005 and October 2009. Paediatric regional anaesthesia applications in 2200 children were retrospectively analysed and included in this study. Demographic data, operation type, choice of regional anaesthesia, local anaesthetics, adjuvant drugs, side effects and complications were recorded.
RESULTS: Mean age was 6 +/- 4 years and mean weight 21.1 +/- 10.7 kg. There were 317 (14.4%) girls, and 1883 (85.6%) boys. Of the 2200 cases studied, 2088 (94%) received caudal epidural block, 59 (3%) received spinal block, 34 (%2) had lumbar epidural block and 19 (1%) received dorsal penile nerve block
CONCLUSION: In paediatric anaesthetic practice, caudal epidural block is used widely. However, paediatric regional anaesthesia should be supported and developed further by obtaining essential materials and devices. Variety of both neuraxial blocks and peripheral nerve blocks under sedation/general anaesthesia should also be increased.

PMID: 22356002 [PubMed – indexed for MEDLINE]