RESEARCH CONDUCTED AT R.V. HAKOBYAN AND CO-AUTHORS HAS PROVIDED NEW INFORMATION ABOUT HYPERTENSION

Gastroenterology Week
July 21, 2008

According to a study from Yerevan, Armenia, "Surgical decompression
is a life-saving procedure in patients with severe intra-abdominal
hypertension. However, it involves subsequent management of an open
abdomen."

"Therefore, it is not recommended for moderate intra-abdominal
hypertension. Our literature search did not show any studies
relating the efficacy of epidural analgesia in decreasing elevated
intra-abdominal pressure (IAP) in critically-ill surgical patients with
primary intra-abdominal hypertension. Through a blinded prospective
study, we investigated postoperative critically-ill surgical
and trauma patients with primary intra-abdominal hypertension,
who received Postoperative thoracic epidural analgesia (n = 58)
or intravenous opioid analgesia (n = 130). Patients in the epidural
group received ropivacaine 0.2% 10 ml, followed by an infusion of
5 ml/h for 96 hours. Patients in the opioid group could receive
morphine hydrochloride (0-1 mg/kg IV for every 4-6 hours as needed)
with or without ketorolac trometamol (up to 90 mg/day IV). IAP
was measured transvesically, for every 6 hours. Additionally,
measurements immediately before and 1 hour after the initiation of
epidural analgesia were taken. Abdominal Perfusion Pressure (APP)
was calculated for each IAP measurement as APP = MAP – IAP where
MAP is the mean arterial pressure. In the epidural group we found a
consistent decrease in IAP from 16.82 +/- 4.56 to 6.30 +/- 3.11 mmHg
and an increase in APP from 60.26 +/- 21.893 to 76.10 +/- 17.54 mmHg
between baseline values until the second day of epidural analgesia,
which remained stable afterwards," wrote R.V. Hakobyan and colleagues
(see also Hypertension).

The researchers concluded: "There were no significant differences
of IAP and APP in the opioid group Conclusion: Continuous thoracic
epidural analgesia decreases IAP and improves APP without haemodynamic
compromise in postoperative critically-ill patients with primary
intra-abdominal hypertension."

Hakobyan and colleagues published the results of their research in
Acta Clinica Belgica (Epidural analgesia decreases intra-abdominal
pressure in postoperative patients with primary intra-abdominal
hypertension. Acta Clinica Belgica, 2008;63(2):86-92).

For additional information, contact R.V. Hakobyan, 16, Quarter 45,
Apt 60, Yerevan 375108, Armenia.

The publisher of the journal Acta Clinica Belgica can be contacted
at: Acta Clinica Belgica, University Hospital Gent, de Pintelaan 185,
Renal Division, B-9000 Ghent, Belgium.