perioperative epidural analgesia . still applicable - prof. ramli

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The Excellent of Neoroaxial Analgesia

PERIOPERATIVE EPIDURAL ANALGESIA:Still Applicable ?

Muhammad Ramli AhmadDepartment of Anesthesiology Faculty of MedicineHasanuddin UniversityMakassar

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INTRODUCTION

Pre- operativeIntraoperativePost operative

SurgeryPeemptive Analgesia Preventive Analgesia

Epidural AnalgesiaPerioperative AnalgesiaKissin I. Anesthesiology 2000;93:1138-43

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SurgeryPainIncidence of Cardiac InfarctionDeranged Pulmonary MechanicsSurgical Stress ResponseTissue InjuryPhysical DangerActivation of neural, metabolic, endocrine, immune & coagulation systemThromboembolic ComplicationsImpaired GIT FunctionBlood Loss & Related Effect?

Cedera pembedahan menginduksi jalur nosiseptif yang mengarah pada aktivasi respon stress neuroendokrin yang berperan pada efek samping luaran perioperatif.3

PERIOPERATIVE EPIDURAL ANALGESIA:Still Applicable ?

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BASIC CONSEP EPIDURAL ANALGESIA" pain free " and "stress free ".Epidural Analgesia

Postoperative pain

Surgical stress response Theoretical benefits for Cardiovascular, Respiratory, Gastrointestinal, and Metabolic function.

" pain free " and not stress free ".Not completely block

1995 - 2000 2010

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The Dynamics of TNF-alpha levels, on both Groups During Observation TimeObservation TimeTNF-alpha Level (pg/ml)SignificanceEpidural Group (n=24)Control Group (n=24)Min - MaxMedianMin - MaxMedianPre Operative 1,08 11,872,261,17 12,342,50p=0,773Early Post Operative0,35 22,111,671,24 32,002,32p=0,6354 Hrs Post Operative0,62 29,372,000,57 32,002,02p=0,3818 Hrs Post Operative0,71 29,371,771,28 20,401,98p=0,35924 Hrs Post Operative1,37 32,003,241,17 20,404,18p=0,091

Data presented in the form of minimum, maximum and median values, and p values were tested with Mann Whitney-U Test. P Value of