Caudal blockade shortens the time to walking exercise in elderly patients following low back surgery

被引:29
作者
Kiribayashi, Masumi [1 ,4 ]
Inagaki, Yoshimi [2 ]
Nishimura, Yukiko [4 ]
Yamasaki, Kazumasa [4 ]
Takahashi, Shunsaku [4 ]
Ueda, Keiichiro [3 ]
机构
[1] Tottori Univ, Fac Med, Dept Anesthesiol, Tottori 6838504, Japan
[2] Tottori Univ, Fac Med, Dept Anesthesiol & Crit Care Med, Tottori 6838504, Japan
[3] Hakuai Hosp, Dept Anesthesiol, Tottori, Japan
[4] Tottori Univ Hosp, Div Operating Theatre, Tottori, Japan
关键词
Caudal block; Preemptive analgesia; Cognitive function; Rehabilitation; PREEMPTIVE ANALGESIA; POSTOPERATIVE PAIN; SEVOFLURANE;
D O I
10.1007/s00540-009-0840-6
中图分类号
R614 [麻醉学];
学科分类号
100217 [麻醉学];
摘要
We conducted a randomized, double-blinded study to test our hypothesis that caudal blockade as preemptive analgesia for low back surgery might accelerate time to walking exercise following surgery and reduce postoperative analgesics, thereby attaining faster recovery of cognitive function. Our study included 51 elderly patients > 70 years with American Society of Anesthesiologists (ASA) physical status 1-3, who underwent lumbosacral surgery under general anesthesia. After anesthetic induction and tracheal intubation, patients in the study group (group B) were injected with simple 0.5% bupivacaine [10 ml x height (m)] as a caudal block 15 min before surgical incision, whereas patients in the control group (group C) received normal saline. After surgery, patients had access to intravenous patient-administered analgesia (IV PCA), fentanyl, for postoperative pain relief. We assessed Mini-Mental State Examination (MMSE) scores before and after the surgery, values of visual analog scale (VAS) for postoperative analgesic status, fentanyl consumption during and for 3 days after surgery, and time to begin walking exercise after surgery. VAS value of group B patients was significantly lower than those in group C throughout the postoperative 48-h period (p < 0.005), and group B patients began walking exercise significantly earlier than those in group C [mean +/- A standard deviation (SD) 70.2 (14.3) in group C, and 61.9 (7.6) in group B; p = 0.0133]. Cognitive function level was higher in group B than in group C patients 24 h after operation. Caudal blockade as preemptive analgesia shortened the time to start walking exercise after surgery and accelerated recovery of postoperative cognitive function.
引用
收藏
页码:192 / 196
页数:5
相关论文
共 14 条
[1]
Effects of preemptive analgesia on pain and cytokine production in the postoperative period [J].
Beilin, B ;
Bessler, H ;
Mayburd, E ;
Smirnov, G ;
Dekel, A ;
Yardeni, I ;
Shavit, Y .
ANESTHESIOLOGY, 2003, 98 (01) :151-155
[2]
SPREAD OF SOLUTIONS INJECTED INTO EPIDURAL SPACE - STUDY USING EPIDUROGRAMS IN PATIENTS WITH LUMBOSCIATIC SYNDROME [J].
BURN, JM ;
GUYER, PB ;
LANGDON, L .
BRITISH JOURNAL OF ANAESTHESIA, 1973, 45 (04) :338-345
[3]
COGNITIVE STATUS AND POSTOPERATIVE PAIN - OLDER ADULTS [J].
DUGGLEBY, W ;
LANDER, J .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1994, 9 (01) :19-27
[4]
MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].
FOLSTEIN, MF ;
FOLSTEIN, SE ;
MCHUGH, PR .
JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198
[5]
The role of postoperative analgesia in delirium and cognitive decline in elderly patients: A systematic review [J].
Fong, HK ;
Sands, LP ;
Leung, JM .
ANESTHESIA AND ANALGESIA, 2006, 102 (04) :1255-1266
[6]
The minimum alveolar concentration (MAC) of sevoflurane with and without nitrous oxide in elderly versus young adults [J].
Fragen, RJ ;
Dunn, KL .
JOURNAL OF CLINICAL ANESTHESIA, 1996, 8 (05) :352-356
[7]
Patient-controlled analgesia [J].
Grass, JA .
ANESTHESIA AND ANALGESIA, 2005, 101 (05) :S44-S61
[8]
Effect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer [J].
Hong, Jeong-Yeon ;
Lim, Kyung T. .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 2008, 33 (01) :44-51
[9]
Epidural ropivacaine anesthesia decreases the bispectral index during the awake phase and sevoflurane general anesthesia [J].
Ishiyama, T ;
Kashimoto, S ;
Oguchi, T ;
Yamaguchi, T ;
Okuyama, K ;
Kumazawa, T .
ANESTHESIA AND ANALGESIA, 2005, 100 (03) :728-732
[10]
Pre-incisional caudal epidural blockade and the relief of pain after lumbar spine operations [J].
Kakiuchi, M ;
Abe, K .
INTERNATIONAL ORTHOPAEDICS, 1997, 21 (01) :62-66