[Epidural blockade for analgesia and treatment of acute pancreatitis].
The effect of a fractional epidural blockade on acute pancreatitis was investigated in a prospective study. PATIENTS AND METHODS. Thoracic (20 patients) or lumbar (six patients) epidural blockade was carried out in 26 patients with severe abdominal conditions comprising sub-ileus in 100%, pancreatic edema indicated by sonography/computer tomography in 57.8%, and necrosis of the pancreas in 34.6%. RESULTS. On average, 3.4 (1-6) injections with single doses of 6-20 ml 0.25% bupivacaine were injected per day. In four patients, morphine (up to 4 mg per 24 h) was added to the local anesthetic. The duration of treatment was between 1 and 15 days. After 10.5% of the injections, the systolic pressure decreased by more than 20%, and after 12.8% of the injections the blood pressure decreased by more than 30%. Hypotension of more than 30% was treated with 0.3 to 0.5 ml theodrenaline (Akrinor) and/or 0.1 to 0.2 mg dihydro-ergotamine (Dihydergot). General analgesics had to be administered in addition on 21.8% of the treatment days and intensive care treatment (artificial ventilation) on 32% of the treatment days. The duration of epidural analgesia varied between 1 and 15 days depending on the intensity of symptoms (pain, ileus). Within 4 days, the enzyme activity of the lipase fell from 8120 to 427 IU, and that of alpha amylase fell from 1401 to 143 IU. In 3 patients laparotomy (for drainage) was performed. An ERCP was carried out in 16 patients. Cardiopulmonary failure necessitated artificial ventilation over a period of 1-15 days in 6 patients; the epidural blockade was continued during the artificial ventilation. Cholecystectomy was carried out as an interval operation in 6 patients. No neurological complications were observed. All patients survived and were discharged from hospital.
Niesel
H C
HC
Anaesthesie-Abteilung, St. Marien- und St. Annastiftskrankenhaus Ludwigshafen/Rh.
Klimpel
L
L
Kaiser
H
H
Bernhardt
A
A
al-Rafai
S
S
Lang
U
U
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D002045:Bupivacaine; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004087:Dihydroergotamine / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy; D008875:Middle Aged; D009020:Morphine; D010195:Pancreatitis / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial; D013806:Theophylline / Q000031:analogs & derivatives / Q000627:therapeutic use
D004338:Drug Combinations; D004087:Dihydroergotamine; C000147:cafedrine, theodrenaline drug combination; D009020:Morphine; D013806:Theophylline; D002045:Bupivacaine
Epidurale Blockade zur Analgesie und Behandlung der akuten Pankreatitis.