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Lobo C, Tufegdzic B. Postoperative pain management after thoracic transplantations. Curr Opin Anaesthesiol 2024:00001503-990000000-00219. [PMID: 39087400 DOI: 10.1097/aco.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE OF REVIEW Heart and lung transplantation evolution marked significant milestones. Pioneering efforts of Dr Christiaan Barnard with the first successful heart transplant in 1967, followed by advancements in heart-lung and single-lung transplants by Drs Bruce Reitz, Norman Shumway, and Joel Cooper laid the groundwork for contemporary organ transplantation, offering hope for patients with end-stage heart and pulmonary diseases. RECENT FINDINGS Pretransplant opioid use in heart transplant recipients is linked to higher mortality and opioid dependence posttransplant. Effective pain control is crucial to reduce opioid-related adverse effects and enhance recovery. However, research on specific pain management protocols for heart transplant recipients is limited. In lung transplantation effective pain management is crucial. Studies emphasize the benefits of multimodal strategies, including thoracic epidural analgesia and thoracic paravertebral blocks, to enhance recovery and reduce opioid use. Perioperative pain control challenges in lung transplantation are unique and necessitate careful consideration to prevent complications and improve outcomes. SUMMARY This review emphasizes the importance of tailored pain management in heart and lung transplant recipients. It advocates for extended follow-up and alternative analgesics to minimize opioid dependency and enhance quality of life. Further high-quality research is needed to optimize postoperative analgesia and improve patient outcomes.
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Affiliation(s)
- Clara Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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2
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Tao X, Luo G, Xiao J, Yao Y, Gao Q, Zou J, Wang T, Cheng Z, Sun D, Yan M. Chronic Postsurgical Pain Following Lung Transplantation: Characteristics, Risk Factors, Treatment, and Prevention: A Narrative Review. Pain Ther 2024; 13:719-731. [PMID: 38809395 PMCID: PMC11254876 DOI: 10.1007/s40122-024-00615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
Chronic pain after lung transplantation (LTx) can substantially reduce quality of life (QoL), yet current consensus guidelines say little about how to prevent or manage it. Research on pain after LTx has tended to focus on acute rather than chronic pain, and it has not extensively examined the factors associated with onset or resolution of chronic pain, which differ from factors influencing chronic pain after general thoracic surgery. This narrative review explores what is known about the epidemiology and risk factors of chronic pain after LTx, as well as effective ways to treat or prevent it. The review identifies key questions and issues that should be the focus of future research.
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Affiliation(s)
- Xinchen Tao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Ge Luo
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Jie Xiao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuanyuan Yao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Qi Gao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Jingcheng Zou
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Tingting Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Dawei Sun
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China.
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Tarrant BJ, Quinn E, Robinson R, Poulsen M, Fuller L, Snell G, Thompson BR, Button BM, Holland AE. Post-operative, inpatient rehabilitation after lung transplant evaluation (PIRATE): A feasibility randomized controlled trial. Physiother Theory Pract 2022:1-11. [PMID: 35193445 DOI: 10.1080/09593985.2022.2041779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative rehabilitation is crucial following lung transplantation (LTx); however, it is unclear whether intensive rehabilitation is feasible to deliver in the acute setting. We aimed to establish the feasibility and safety of intensive acute physiotherapy post-LTx. METHODS This feasibility trial randomized 40 adults following bilateral sequential LTx to either standard (once-daily) or intensive (twice-daily) physiotherapy. Primary outcomes were feasibility (recruitment and delivery of intensive intervention) and safety. Secondary outcomes included six-minute walk test; 60-second sit-to-stand; grip strength; physical activity; pain; EQ-5D-5L; length of stay; and readmissions. Data were collected at baseline, week 3, and week 10 post-LTx. ClinicalTrials.gov #NCT03095859. RESULTS Of 83 LTx completed during the trial, 49% were eligible and 48% provided consent. Median age was 61 years {range 18-70}; waitlist time 85 days [IQR 35-187]. Median time to first mobilization was 2 days [2-3]. Both groups received a median of 10 [7-14] standard interventions post-randomization. A median of 9 [6-18] individual intensive interventions were attempted (86% successful), the most common barrier being medical procedures/investigations (67%). No intervention-related adverse events or between-group differences in secondary outcomes were observed. CONCLUSIONS Acute, intensive physiotherapy was feasible and safe post-LTx. This trial provides data to underpin definitive trials to establish efficacy.
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Affiliation(s)
- Benjamin J Tarrant
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,Level 4, The Alfred Centre, La Trobe University, Melbourne, VIC, Australia
| | - Elizabeth Quinn
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Robinson
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Megan Poulsen
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Louise Fuller
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,John St, Swinburne University, Hawthorn, VIC, Australia
| | - Greg Snell
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
| | - Bruce R Thompson
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,John St, Swinburne University, Hawthorn, VIC, Australia
| | - Brenda M Button
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,Level 4, The Alfred Centre, La Trobe University, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
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Lewis TC, Sureau K, Katz A, Fargnoli A, Lesko M, Rudym D, Angel LF, Chang SH, Kon ZN. Multimodal opioid-sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block. Clin Transplant 2021; 36:e14512. [PMID: 34658078 DOI: 10.1111/ctr.14512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
Opioid analgesics are commonly used post-lung transplant, but have many side effects and are associated with worse outcomes. We conducted a retrospective review of all lung transplant recipients who were treated with a multimodal opioid-sparing pain protocol. The use of liposomal bupivacaine intercostal nerve block was variable due to hospital restrictions. The primary objective was to describe opioid requirements and patient-reported pain scores early post-lung transplant and to assess the impact of intraoperative liposomal bupivacaine intercostal nerve block. We treated 64 lung transplant recipients with our protocol. Opioid utilization decreased to a mean of 43 milligram oral morphine equivalents by postoperative day 4. Median pain scores peaked at 4 on postoperative day 1 and decreased thereafter. Only three patients were discharged home with opioids, all of whom were taking opioid agonist therapy pre-transplant for opioid use disorder. Patients who received liposomal bupivacaine intercostal nerve block in the operating room had a significant reduction in opioid consumption over postoperative day 1 through 4 (228 mg vs. 517 mg, P= .032). A multimodal opioid-sparing pain management protocol is feasible and resulted in weaning of opioids prior to hospital discharge.
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Affiliation(s)
- Tyler C Lewis
- Department of Pharmacy, NYU Langone Health, New York, New York, USA.,Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Kimberly Sureau
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Alyson Katz
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | - Anthony Fargnoli
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Melissa Lesko
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Darya Rudym
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Luis F Angel
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, Northwell Health, Manhasset, New York, USA
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Moyano J, Rodríguez P, Fierro CL. Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.75649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain, however little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for the management of acute pain when other analgesics have failed to do so.Case presentation: The case of a male patient with acute pain in the postoperative period of single-lung transplantation is presented. Opioids and non-opioid analgesics showed limited efficacy, so the systematic administration of lidocaine was decided. Systemic lidocaine was effective for pain control, functional recovery and opioid decrease during the postoperative period.Conclusions: Systemic lidocaine was a useful drug for postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options have failed; however its routine use is not recommended.
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Klinger RY, Cunniff C, Mamoun N, Cooter M, Hashmi N, Hopkins T, Smith P, Hartwig M, Bottiger B. Patient-Reported Chronic Pain Outcomes After Lung Transplantation. Semin Cardiothorac Vasc Anesth 2019; 24:96-103. [DOI: 10.1177/1089253219882432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic pain after lung transplantation is a significant concern, in particular given the heterogeneity of the patient population and the challenges of achieving adequate pain control amid concerns related to complex immunosuppressant regimens and the possibility of respiratory depression. We undertook a patient-reported outcomes (PRO) survey administered via our electronic health care portal to examine the postoperative incisional pain prevalence in a cohort of lung transplant recipients at a single, high-volume center where bilateral thoracosternotomy is the preferred surgical approach. The Patient Reported Outcomes Measurement Information System (PROMIS) Global Health and Pain Intensity short forms were sent to a total of 173 lung transplant recipients who were more than 2 months postsurgery at the time of the study. A total of 64 patients responded to both PROMIS surveys (response rate 38%). In the cohort of survey respondents, we observed a chronic pain incidence of 58% after lung transplantation (median pain score 1/10) and an overall good quality of life score (median score 4/5); however, only 9.4% reported moderate-severe pain (pain score ≥5/10). Survey nonrespondents had higher rates of pretransplant opioid and psychiatric medication use compared with respondents. In this study, we demonstrated the feasibility of using an electronic PRO survey for assessing postoperative pain outcomes after lung transplantation. However, measuring pain outcomes using this type of tool highlights issues of response rate and potential selection bias. Larger studies are needed to adequately assess the risk and predictors of chronic pain after lung transplantation and its impact on quality of life.
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Rhomboid intercostal and sub-serratus (RISS) plane block for analgesia after lung transplant. J Clin Anesth 2019; 56:85-87. [DOI: 10.1016/j.jclinane.2019.01.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/19/2022]
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Anderson AJ, Marciniak D. Bilateral Serratus Anterior Plane (SAP) Catheters: ANovel Approach to Promote Postoperative Recovery After Bilateral Sequential Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1353-1355. [DOI: 10.1053/j.jvca.2018.07.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Indexed: 11/11/2022]
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9
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Gelzinis TA. An Update on Postoperative Analgesia Following Lung Transplantation. J Cardiothorac Vasc Anesth 2018; 32:2662-2664. [DOI: 10.1053/j.jvca.2018.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 11/11/2022]
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10
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Fuller LM, El-Ansary D, Button B, Bondarenko J, Marasco S, Snell G, Holland AE. Reliability of sternal instability scale (SIS) for transverse sternotomy in lung transplantation (LTX). Physiother Theory Pract 2018; 34:931-934. [DOI: 10.1080/09593985.2018.1431342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Louise M Fuller
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Bundoora, Victoria Australia
| | - Doa El-Ansary
- Physiotherapy Department, The University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | - Brenda Button
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
- Monash University Physiotherapy Department, Clayton Campus, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Greg Snell
- Respiratory Department, The Alfred Hospital, Lung Transplant Services, Melbourne, Victoria, Australia
| | - Anne E Holland
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Bundoora, Victoria Australia
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Farquhar JM, Smith PJ, Snyder L, Gray AL, Reynolds JM, Blumenthal JA. Patterns and predictors of pain following lung transplantation. Gen Hosp Psychiatry 2018; 50:125-130. [PMID: 29190571 DOI: 10.1016/j.genhosppsych.2017.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our objective was to examine variability in pain levels following lung transplantation, and examine individual biopsychosocial factors influencing changes in pain. METHOD We performed a retrospective study of a cohort of 150 patients transplanted and discharged from Duke University Hospital between January 2015 and September 2016. During hospitalization and at clinic visits up to two months after discharge, subjective pain ratings were obtained using a 0-10 Numeric Rating Scale. Psychiatric diagnoses of anxiety and depression and Center for Epidemiological Studies - Depression (CES-D) scores collected after hospital discharge were examined as predictors of post-surgery pain. Medical and surgical variables were examined as covariates. RESULTS During hospitalization, pain ratings decreased over time (p<0.001). Predictors of higher pain levels included pre-transplant history of depression (p=0.001) and anxiety (p=0.04), bilateral lung transplant (p=0.03), and lower six-minute walk distance (p=0.02). Two months after discharge, 18% of patients reported continued pain and 34% remained on opioid pain medications. Two months after discharge, more frequent post-operative complications predicted higher pain levels in a univariate analysis (p=0.02) although this relationship was attenuated after adjustment for depression. In a multivariate analysis, elevated CES-D scores (p=0.002), and greater opioid use (p=0.031) predicted higher pain levels 2-months post-discharge. CONCLUSION We conclude that patients with psychiatric comorbidities may be at risk for greater pain, and may require additional strategies for more effective pain management.
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Affiliation(s)
- Julia M Farquhar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Laurie Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alice L Gray
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John M Reynolds
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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Hutchins J, Apostolidou I, Shumway S, Kelly R, Wang Q, Foster C, Loor G. Paravertebral Catheter Use for Postoperative Pain Control in Patients After Lung Transplant Surgery: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2017; 31:142-146. [DOI: 10.1053/j.jvca.2016.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 11/11/2022]
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13
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Cason M, Naik A, Grimm JC, Hanna D, Faraone L, Brookman JC, Shah A, Hanna MN. The Efficacy and Safety of Epidural-Based Analgesia in a Case Series of Patients Undergoing Lung Transplantation. J Cardiothorac Vasc Anesth 2015; 29:126-32. [DOI: 10.1053/j.jvca.2014.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Indexed: 11/11/2022]
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Esguerra-Gonzalez A, Ilagan-Honorio M, Fraschilla S, Kehoe P, Lee AJ, Marcarian T, Mayol-Ngo K, Miller PS, Onga J, Rodman B, Ross D, Sommer S, Takayanagi S, Toyama J, Villamor F, Weigt SS, Gawlinski A. CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy. Am J Crit Care 2013; 22:115-24. [PMID: 23455861 DOI: 10.4037/ajcc2013869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).
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Affiliation(s)
- Angeli Esguerra-Gonzalez
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Monina Ilagan-Honorio
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Stephanie Fraschilla
- Stephanie Fraschilla and Jay Onga are transplant coordinators for the heart and lung transplant program at Ronald Reagan University of California Los Angeles Medical Center
| | - Priscilla Kehoe
- Priscilla Kehoe is the director of research and Sumiko Takayanagi is a senior statistician in the School of Nursing at the University of California Los Angeles
| | - Ai Jin Lee
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Taline Marcarian
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Kristina Mayol-Ngo
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Pamela S. Miller
- Pamela S. Miller is a postdoctoral scholar in the School of Nursing at the University of California San Francisco
| | - Jay Onga
- Stephanie Fraschilla and Jay Onga are transplant coordinators for the heart and lung transplant program at Ronald Reagan University of California Los Angeles Medical Center
| | - Betty Rodman
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - David Ross
- David Ross is a physician, professor, and medical director of the lung and heart-lung transplant program and S. Samuel Weigt is a physician and assistant professor in the Division of Pulmonary and Critical Care Medicine at David Geffen School of Medicine at University of California Los Angeles Medical Center
| | - Susan Sommer
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Sumiko Takayanagi
- Priscilla Kehoe is the director of research and Sumiko Takayanagi is a senior statistician in the School of Nursing at the University of California Los Angeles
| | - Joy Toyama
- Joy Toyama is a DrPH student in the Department of Biostatistics and a graduate student researcher in the School of Nursing at the University of California Los Angeles
| | - Filma Villamor
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - S. Samuel Weigt
- David Ross is a physician, professor, and medical director of the lung and heart-lung transplant program and S. Samuel Weigt is a physician and assistant professor in the Division of Pulmonary and Critical Care Medicine at David Geffen School of Medicine at University of California Los Angeles Medical Center
| | - Anna Gawlinski
- Anna Gawlinski is the director of research and evidence-based practice at Ronald Reagan University of California Los Angeles Medical Center and adjunct professor in the School of Nursing at the University of California Los Angeles
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15
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Fuller L, El-Ansary D, Nelson EM, Gooi J. External chest brace for clam shell sternal instability following bilateral sequential lung transplant: a case series. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.4.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: A common surgical incision for bilateral lung transplantation is the ‘clam shell’ approach via bilateral anterior thoracotomies and a transverse sternotomy to allow for the replacement of the lungs sequentially (Macchiarini et al, 1999; Karnak et al, 2006 ). Although popular, the clam shell incision (CSI) can be associated with significant postoperative pain, bony overriding or disruptions at the sternotomy site in 32%-60% of patients (Macchiarini et al, 1999; Venuta et al, 2003 ; Richards et al, 2004 ; Karnak et al, 2006 ). The subsequent non-union and sternal instability cause significant morbidity and mortality with reported rates of 34% and 26%, respectively ( Karnak et al, 2006 ). Content: The literature revealed a myriad of surgical approaches to this clinical problem, but a paucity of conservative external chest bracing solutions for transverse sternal instability. This case series describes the clinical management of three post bilateral sequential lung transplant (BSLTX) recipients that necessitated the design and development of a custom made external chest orthosis (brace) with input from a multidisciplinary team. Conclusion: This brace is offered as a solution for transverse sternal instability and pain following lung transplantation.
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Affiliation(s)
- Louise Fuller
- Transplant Services, Physiotherapy Dept, The Alfred Hospital Melbourne, Victoria, Australia
| | - Doa El-Ansary
- Physiotherapy Dept, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Elysia M Nelson
- Orthotic & Prosthethic Dept, The Alfred Hospital Melbourne, Victoria, Australia
| | - Julian Gooi
- Cardiothoracic Surgery Dept, The Alfred Hospital Melbourne, Victoria, Australia
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Girard F, Chouinard P, Boudreault D, Poirier C, Richard C, Ruel M, Ferraro P. Prevalence and impact of pain on the quality of life of lung transplant recipients: a prospective observational study. Chest 2006; 130:1535-40. [PMID: 17099034 DOI: 10.1378/chest.130.5.1535] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To study the prevalence and impact of pain on the quality of life (QOL) of lung transplant recipients. DESIGN AND PATIENTS Prospective, observational, cross-sectional study. Ninety-six lung transplant recipients (> 3 months after transplantation) completed questionnaires measuring the severity and impact of pain (Brief Pain Inventory), anxiety (State Trait Anxiety Inventory), QOL (Short Form-36 version 2 [SF-36v2]), and depression (Beck Depression Inventory [BDI]). SETTING University medical center lung transplant outpatient clinic. RESULTS The prevalence of pain in lung transplant recipients was 49%. Patients with pain were older, more likely to have undergone unilateral lung transplantation (64% vs 40%, p = 0.03), and were more likely to have lung emphysema (55% vs 38%, p = 0.004). Only a pulmonary diagnosis of lung emphysema remained an independent predictor for postoperative pain in a logistic regression model. Average (+/- SD) score of the BDI was 9.6 +/- 7.8 and 5.8 +/- 5.8 (p = 0.005) for patients with and without pain, respectively. Patients with and without pain did not significantly differ in terms of anxiety. Pain-free patients had a significantly higher physical component score than patients with pain in the SF-36v2 (mean, 48.7 +/- 8.6 vs 38.6 +/- 9.8, p < 0.0001, respectively), while the mental component scores were not statistically different between the two groups. CONCLUSIONS Lung transplant recipients have a high prevalence of pain. Patients with lung emphysema as their preoperative diagnosis are more likely to have pain. The occurrence of pain is associated with a decreased QOL in lung transplant recipients.
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Affiliation(s)
- François Girard
- Department of Anesthesiology, CHUM Hopital Notre-Dame, Montreal, Canada, H2L 4M1.
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Abstract
Adequate postoperative analgesia prevents unnecessary patient discomfort. It may also decrease morbidity, postoperative hospital length of stay and, thus, cost. Achieving optimal pain relief after cardiac surgery is often difficult. Many techniques are available, and all have specific advantages and disadvantages. Intrathecal and epidural techniques clearly produce reliable analgesia in patients undergoing cardiac surgery. Additional potential benefits include stress response attenuation and thoracic cardiac sympathectomy. The quality of analgesia obtained with thoracic epidural anesthetic techniques is sufficient to allow cardiac surgery to be performed in awake patients without general endotracheal anesthesia. However, applying regional anesthetic techniques to patients undergoing cardiac surgery is not without risk. Side effects of local anesthetics (hypotension) and opioids (pruritus, nausea/vomiting, urinary retention, and respiratory depression), when used in this manner, may complicate perioperative management. Increased risk of hematoma formation in this scenario has generated much of lively debate regarding the acceptable risk-benefit ratio of applying regional anesthetic techniques to patients undergoing cardiac surgery.
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Affiliation(s)
- Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois 60637, USA.
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