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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2004 January-February;70(1-2):83-9


language: English, Italian

Cytopathologic examination of epidural catheter for postoperative analgesia. Pathophysiology and clinical management

Carrossino D. 1, Zappi L. 1, Gipponi M. 2, Bassetti C. 3, Maurelli A. 1, Mignone L. 1, Villani L. 1, Spina B. 4, Tami M. 5, Cecchini A. 5, Calandri P. G. 1

1 Anesthesia and Resuscitation Unit National Cancer Research Institute (IST) Genoa, Italy 2 Surgical Oncology Unit National Cancer Research Institute (IST) Genoa, Italy 3 Obstetric Anesthesia Unit Anesthesia and Resuscitation Service San Martino Hospital, Genoa, Italy 4 Anatomy and Cytopathology Unit National Cancer Research Institute (IST) Genoa, Italy 5 Anesthesia and Resuscitation Unit Villa Scassi, Genoa, Italy


Aim. The ­authors per­formed a pros­pec­tive ­study in a ­series of ­patients under­go­ing com­bined gen­er­al and epi­du­ral anaesthe­sia for ­major abdom­i­nal sur­gery in ­order to ­define if the epi­du­ral cath­e­ter insert­ed for post­op­er­a­tive anal­ge­sia ­induced in the ­short-­term (7-8 post­op­er­a­tive ­days) any cyto­path­o­log­i­cal­ly appre­ciable inflam­ma­to­ry ­response.
Methods. From April to September 2001, 20 con­sec­u­tive ­patients under­go­ing com­bined gen­er­al and epi­du­ral anaesthe­sia for ­major abdom­i­nal sur­gery at the National Cancer Research Institute and Villa Scassi Hospital (Genoa), ­were recruit­ed ­after obtain­ing Institutional Ethics Committee approv­al and writ­ten con­sent ­from the ­patients. The stan­dard tech­nique for epi­du­ral anaesthe­sia was adopt­ed. Preoperatively, all ­patients ­received per­i­du­ral­ly a ­dose ­test of 3 ml of 2% lid­o­caine (60 mg) fol­lowed by 5 ml of ropiv­a­caine 0.75%, and a con­tin­u­ous infu­sion of ropiv­a­caine 0.375% (5-10 ml/h; max­i­mal ­dose=20 ml) intra­op­er­a­tive­ly. As ­regards the ther­a­peu­tic man­age­ment of post­op­er­a­tive anal­ge­sia, ­patients ­received a con­tin­u­ous infu­sion of ropiv­a­caine 0.2% for at ­least 48 hours and sup­ple­men­tal ­bolus (2 mg/die) of mor­phine hydro­chlo­ride. The epi­du­ral cath­e­ter was ­always ­removed ­between the 7th and 8th post­op­er­a­tive day, and it was exam­ined by the pathol­o­gist accord­ing to the Thin Prep 2000 pro­ce­dure.
Results. The cyto­path­o­log­ic exam­ina­tion of the tip of the epi­du­ral cath­e­ter ­gave the fol­low­ing find­ings: amor­phous mate­ri­al with­out ­cells (n=10); ­rare gran­u­loc­y­tes and his­tio­cy­tes (n=6); stro­mal ­cells (n=3), and ­rare lym­pho­cytes (n=1).
Conclusion. We ­were ­unable to ­detect any cyto­path­o­log­i­cal­ly appre­ciable inflam­ma­to­ry ­res-ponse at the tip of the epi­du­ral cath­e­ter ­which ­could ­have sug­gest­ed the occur­rence of inflam­ma­tion in the epi­du­ral tis­sues. Given the pos­i­tive ­results of pro­phy­lac­tic epi­du­ral admin­is­tra­tion of ­small dos­es of cor­ti­cos­ter­oids in the reduc­tion of ­postepi­du­ral anaesthe­sia ­back ­pain and ­their ­direct mem­brane ­action on noc­i­cep­tive C-­fibers, ­this ­kind of back­ache ­seems to be relat­ed to the stim­u­la­tions of ­such noc­i­cep­tors ­more ­than to a cath­e­ter-relat­ed inflam­ma­to­ry ­response of epi­du­ral tis­sues ­with pos­sible evo­lu­tion in per­i­du­ral fibro­sis, as report­ed fol­low­ing sur­gi­cal inter­ven­tion for lum­bos­a­cral dis­ease.

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