Chapter 23. Epidural Anesthesia and Analgesia
Which is not a potential benefit of epidural anesthesia in patients undergoing total hip arthroplasty?
A. Reduction in operative time
B. Reduced deep vein thrombosis (DVT)
D. Less postoperative cognitive dysfunction
E. Less perioperative hypotension
E is correct. Hypotension is a common side effect of epidural anesthesia due to sympathectomy.
A, B, C, and D are incorrect. Studies have proven turnover and operative time is faster when the patient receives neuraxial anesthesia (option A). Other benefits of epidural anesthesia for total hip arthroplasty include a lower incidence of postoperative DVT (option B), a shorter hospital stay (option C), and less postoperative cognitive dysfunction (option D).
Which statement is correct regarding epidural analgesia and anesthesia for lower limb vascular surgery?
A. It should not be used due to the need for perioperative anticoagulation.
B. Only mixtures with epinephrine may be used.
C. It should not be used due to the frequent comorbidities of peripheral arterial occlusive disease (PAOD) patients.
D. It improves graft patency.
E. General anesthesia (GA) is superior in most large studies.
D is correct. Evidence suggests epidural anesthesia promotes graft patency.
A is incorrect. Perioperative anticoagulation is needed in many vascular procedures; however, the perioperative dosing regimen usually does not augment the risk of epidural hematoma.
B is incorrect. Epinephrine is used to prolong the block, uptake occurs but is unlikely to result in clinical significant vasopressive or inotropic effect.
C is incorrect. Avoiding GA is beneficial in the majority of patients with comorbidities such as coronary artery disease.
E is incorrect. Conflicting evidence exists on this matter; however, most studies suggest a better outcome with neuraxial anesthesia.
A patient undergoing cystectomy requires a block up to which sensory level to attain adequate analgesia?
A is correct. T4. The bladder is innervated by T9–T10, but the incision and traction on the viscera requires a sensory level block until level T4.