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Hsu J, Yu SP, Pan CT, Huang PM. Stripping Massage and Literature Review in Post-Thoracoscopic Chest Pain Management. Thorac Cardiovasc Surg 2024; 72:465-475. [PMID: 37490933 DOI: 10.1055/a-2137-9035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The aim of this randomized study was to investigate whether stripping massage (SM) of myofascial trigger points in the lower rhomboid muscle could alleviate chest pain in patients following thoracoscopic surgery. In addition, a literature review was conducted to assess the effectiveness of various pain management techniques. Sixty adult patients who reported a visual analog scale (VAS) score of 4 or higher were randomly assigned to receive conventional analgesics alone (conventional group) or combined with SM twice daily for 2 weeks (SM group). VAS scores and the use of additional analgesics were evaluated on postoperative days 1, 3, 7, 14, and 30. Using the PubMed and Cochrane Library databases, a review of current pain management techniques was carried out up to January 31, 2022. A subgroup analysis was also performed to examine the treatment effect during different surgical periods and techniques. Results showed that the SM group had significantly lower VAS scores on postoperative days 3, 7, 14, and 30 (p < 0.001), as well as a shorter hospitalization duration and reduced need for additional analgesics (p < 0.001). The literature review included a total of 20 studies (2,342 cases of chest pain relief after thoracoscopic surgery), which indicated that serratus anterior plane (SAP) blocks were commonly used as a perioperative approach to reduce pain and opioid consumption. SM and SAP can both serve as adjuvant treatments for chest pain in patients following thoracoscopic surgery, with SM being a safe and noninvasive pain control option after hospital discharge.
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Affiliation(s)
- Jiun Hsu
- National Taiwan University Hospital Yunlin Branch, YunLin County, Taiwan
| | - Sheng-Pin Yu
- National Taiwan University Hospital Yunlin Branch, YunLin County, Taiwan
| | - Chien-Te Pan
- National Taiwan University Hospital Yunlin Branch, YunLin County, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Gergen AK, Madsen HJ, Rocker AJ, White AM, Jones K, Merrick DT, Park D, Rove JY. Making a Painless Drain: Proof of Concept. Semin Thorac Cardiovasc Surg 2022; 36:120-128. [PMID: 36245098 DOI: 10.1053/j.semtcvs.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Chest tubes account for a large proportion of postoperative pain after cardiothoracic operations. The objective of this study was to develop a novel, cost-effective, easy-to-use, lidocaine-eluting coating to reduce pain associated with postoperative chest tubes. A lidocaine-eluting hydrogel was developed by dispersing lidocaine-loaded nanoparticles in an aqueous solution containing gelatin (5%). Glutaraldehyde (1%) was added to crosslink the gelatin into a hydrogel. The hydrogel was dehydrated, resulting in a thin, stable polymer. Sterile lidocaine hydrogel-coated silicone discs and control discs were prepared and surgically implanted in the subcutaneous space of C57B6 mice. Using von Frey filaments, mice underwent preoperative baseline pain testing, followed by pain testing on post-procedure day 1 and 3. On post-procedure day 1, mice implanted with control discs demonstrated no change in pain tolerance compared to baseline, while mice implanted with 20 mg and 80 mg lidocaine-loaded discs demonstrated a 2.4-fold (P = 0.36) and 4.7-fold (P = 0.01) increase in pain tolerance, respectively. On post-procedure day 3, mice implanted with control discs demonstrated a 0.7-fold decrease in pain tolerance compared to baseline, while mice implanted with 20 mg and 80 mg lidocaine-loaded discs demonstrated a 1.8-fold (P = 0.88) and 8.4-fold (P = 0.02) increase in pain tolerance, respectively. Our results demonstrate successful development of a lidocaine-eluting chest tube with hydrogel coating, leading to improved pain tolerance in vivo. The concept of a drug-eluting drain coating has significant importance due to its potential universal application in a variety of drain types and insertion locations.
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Affiliation(s)
- Anna K Gergen
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Helen J Madsen
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Adam J Rocker
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Allana M White
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kendra Jones
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Daniel T Merrick
- Department of Pathology, University of Colorado Anschutz Medical Campus,Aurora, CO
| | - Daewon Park
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jessica Y Rove
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
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Yazdani E, Nasr-Esfahani M, Kolahdouzan M, Pourazari P. Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures. Adv Biomed Res 2022; 11:66. [PMID: 36325169 PMCID: PMC9621344 DOI: 10.4103/abr.abr_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/11/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background: There are several methods to control pain, especially in traumatic patients with rib fractures. Intrapleural analgesia (IPA) and intercostal block methods are recommended in patients with rib fractures to control pain. Here, we aimed to evaluate and compare the effects of IPA and intercostal block on patients’ clinical conditions. Materials and Methods: This is a randomized clinical trial that was performed in 2020–2021 on thirty traumatic patients with rib fractures. We collected the results of arterial blood gas in all patients before interventions including HCO3, pH, pO2, and pCO2 and also evaluated pain of patients. The first group underwent intercostal blockade with standard method with bupivacaine, and for the second group of patients, a chest tube was implanted. Patients were monitored for up to 12 h for pain intensity and need for analgesics. Results: The mean levels of HCO3 decreased in both groups after the interventions, and this decrease was more significant in patients in the intercostal blockade group (P < 0.05). The mean levels of pO2 increased in both groups after interventions, especially in patients in the intercostal blockade group (P < 0.05). The mean pCO2 levels also decreased in both groups (P < 0.05). The mean pain intensity in both groups decreased significantly after the intervention (P < 0.05) and also the mean pain intensity in the intercostal blocking group decreased significantly more than the group treated with chest tube (P < 0.05). Conclusion: Intercostal blockade through bupivacaine is more effective than chest tube administration of bupivacaine in patients with rib fractures.
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Chen Y, Cai Y, Ye Y, Xia Y, Papadimos TJ, Liu L, Xu X, Wang Q, Shi K, Wu Y. Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study. J Pain Res 2021; 14:785-791. [PMID: 33776475 PMCID: PMC7989531 DOI: 10.2147/jpr.s295913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Intrapleural analgesia has been increasingly recommended for postoperative analgesia after thoracic surgery. However, the analgesic effect provided by a single intrapleural administration is time limited. This study reports the efficacy and safety of repeated intrapleural 0.75% ropivacaine administration after thoracoscopic surgery. Methods Twenty patients were randomly divided into two groups: a single administration group receiving a single intrapleural injection of 0.75% ropivacaine 15 mL (single administration group, SA group), and a repeated administration group with an intrapleural injection of 0.75% ropivacaine 15 mL every 4h for 4 doses (repeated administration group, RA group). The primary outcomes of this study were the peak plasma concentration of ropivacaine and 24h morphine consumption. The secondary outcomes were pain score, patient satisfaction, extubation time, hospital length of stay, and adverse reactions. Results In SA group, the highest plasma concentration after intrapleural administration of 0.75% ropivacaine 15 mL was 1345±364 μg/L. The highest plasma concentration in RA group after the fourth administration was 1864±492 μg/L. The 24h morphine consumption in RA group was significantly less than that in SA group (9.0±5.66 vs 15.9±3.48 mg, P=0.004). The NRS scores at rest and while coughing of patients in RA group were significantly lower than those in SA group at 5, 9, 13, 17 and 24h after operation. The patients in RA group had higher satisfaction than those in SA group. There was no significant difference in postoperative adverse events, drainage tube placement days and hospital length of stay between the two groups. Conclusion Repeated intrapleural administration with 0.75% ropivacaine, 15 mL every 4h for 4 doses after video-assisted thoracoscopic lobectomies, can provide a more durable and more effective analgesic effect than single intrapleural administration. Repeated intrapleural administration of ropivacaine is an effective postoperative method of analgesia resulting in higher patient satisfaction. Moreover, it was also able to keep the plasma concentration of ropivacaine within a possible safe range. Clinical Trial Registration Number ChiCTR-IOR-17010560.
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Affiliation(s)
- Yuanqing Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Yaoyao Cai
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Yingchao Ye
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Yun Xia
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Le Liu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Xuzhong Xu
- Private Anesthesiology Consultant, Wenzhou, People's Republic of China
| | - Quanguang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Kejian Shi
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Yiquan Wu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
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Cogan J, André M, Ariano-Lortie G, Nozza A, Raymond M, Rochon A, Vargas-Shaffer G. Injection of Bupivacaine into the Pleural and Mediastinal Drains: A Novel Approach for Decreasing Incident Pain After Cardiac Surgery - Montreal Heart Institute Experience. J Pain Res 2020; 13:3409-3413. [PMID: 33364824 PMCID: PMC7751296 DOI: 10.2147/jpr.s279071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background We conducted a chart review of prospectively collected data in order to demonstrate the safety and efficacy of an innovative technique of pleural and mediastinal drain injections. Methods Patients who had undergone cardiac surgery and who continued to have pain despite the use of a multimodal pain protocol received injections of 20 mL of 0.25% bupivacaine in pleural and/or mediastinal chest drainage tubes. Results Patients were evaluated for the incidence mediastinitis, osteitis, and deep sternal wound infection as well as the speed and intensity of pain relief. The odds ratio of infection in the infused group was 0.955 (CI = 0.4705, 1.9384). The adjusted mean “decrease in pain” was 4.01 (SEM = 0.15 and 95% CI = 3.78, 4.38), using the 11-point Likert Numerical Rating Scale. The mean adjusted “time to maximum pain relief” was 8.33 minutes (SEM = 0.42 and 95% CI = 7.50, 9.15). Conclusion This technique is a powerful, safe, and efficient tool in the armamentarium of pain management and its growing use within our institution has provided a substantial benefit in the treatment of early post-operative pain.
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Affiliation(s)
- Jennifer Cogan
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Maud André
- Department of Nursing, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | | | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, QC H1Y 3N1, Canada
| | - Meggie Raymond
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Grisell Vargas-Shaffer
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 3E4, Canada
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Haager B, Schmid D, Eschbach J, Passlick B, Loop T. Regional versus systemic analgesia in video-assisted thoracoscopic lobectomy: a retrospective analysis. BMC Anesthesiol 2019; 19:183. [PMID: 31623571 PMCID: PMC6798473 DOI: 10.1186/s12871-019-0851-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background The optimal perioperative analgesic strategy in video-assisted thoracic surgery (VATS) for anatomic lung resections remains an open issue. Regional analgesic concepts as thoracic paravertebral or epidural analgesia were used as systemic opioid application. We hypothesized that regional anesthesia would provide improved analgesia compared to systemic analgesia with parenteral opioids in VATS lobectomy and would be associated with a lower incidence of pulmonary complications. Methods The study was approved by the local ethics committee (AZ 99/15) and registered (germanctr.de; DRKS00007529, 10th June 2015). A retrospective analysis of anesthetic and surgical records between July 2014 und February 2016 in a single university hospital with 103 who underwent VATS lobectomy. Comparison of regional anesthesia (i.e. thoracic paravertebral blockade (group TPVB) or thoracic epidural anesthesia (group TEA)) with a systemic opioid application (i.e. patient controlled analgesia (group PCA)). The primary endpoint was the postoperative pain level measured by Visual Analog Scale (VAS) at rest and during coughing during 120 h. Secondary endpoints were postoperative pulmonary complications (i.e. atelectasis, pneumonia), hemodynamic variables and postoperative nausea and vomiting (PONV). Results Mean VAS values in rest or during coughing were measured below 3.5 in all groups showing effective analgesic therapy throughout the observation period. The VAS values at rest were comparable between all groups, VAS level during coughing in patients with PCA was higher but comparable except after 8–16 h postoperatively (PCA vs. TEA; p < 0.004). There were no significant differences on secondary endpoints. Intraoperative Sufentanil consumption was significantly higher for patients without regional anesthesia (p < 0.0001 vs. TPVB and vs. TEA). The morphine equivalence postoperatively applicated until POD 5 was comparable in all groups (mean ± SD in mg: 32 ± 29 (TPVB), 30 ± 27 (TEA), 36 ± 30 (PCA); p = 0.6046). Conclusions Analgesia with TEA, TPVB and PCA provided a comparable and effective pain relief after VATS anatomic resection without side effects. Our results indicate that PCA for VATS lobectomy may be a sufficient alternative compared to regional analgesia. Trial registration The study was registered (germanctr.de; DRKS00007529; 10th June, 2015).
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Affiliation(s)
- Benedikt Haager
- Department of Thoracic Surgery, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Daniel Schmid
- Department of Thoracic Surgery, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.,Department of Anesthesiology and Intensive Care Medicine, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Joerg Eschbach
- Department of Anesthesiology and Intensive Care Medicine, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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Chen S, Zhu X, Huang L, Chen W, Zhang S, Shi H, Xia Y, Papadimos TJ, Xu X. Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study. Int J Surg 2019; 69:132-138. [PMID: 31150800 DOI: 10.1016/j.ijsu.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/11/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pain due to coughing after thoracoscopic surgery remains a clinical problem, and its relief by intrapleural analgesia has not been extensively studied. This study attempts to determine the suitable volume of 0.75% ropivacaine needed for intrapleural analgesia after thoracoscopic surgery. METHODS A double-blind, randomized, controlled trial was performed. Forty-five patients were randomly divided into three groups: R20, R15, and R10 (n = 15); 20 ml, 15 ml, or 10 ml of 0.75% ropivacaine was injected into the pleural cavity of each patient in the 3 groups, respectively, when the pain score from postoperative coughing was ≥4. The primary outcome was pain score upon coughing (C-NRS), and the secondary outcomes were pain score at rest (R-NRS), morphine consumption, time of onset, and duration of intrapleural analgesia. RESULTS All patients in the R20 and R15 groups reported effective pain relief after intrapleural injection when postoperative coughing occurred. However, only 7 patients in the R10 group reported effective relief of pain. Compared with the patients in the R10 group, patients in the R20 and R15 groups had lower C-NRS scores, less morphine consumption at 8 h and 24 h, a shorter time to pain relief, and a longer duration of analgesia. There was no significant difference of R-NRS among the three groups. CONCLUSION Intrapleural analgesia with 0.75% ropivacaine at a volume of 15 ml or 20 ml effectively relieved pain due to coughing after thoracoscopic surgery. TRIAL REGISTRATION ChiCTR1800017515.
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Affiliation(s)
- Sisi Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.
| | - Xiaona Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.
| | - Lvdan Huang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.
| | - Wei Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China; Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
| | - Sainan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China; Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
| | - Hongying Shi
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, China.
| | - Yun Xia
- Department of Anesthesiology, Ohio State University Medical Center, Columbus, USA.
| | - Thomas J Papadimos
- Department of Anesthesiology, Ohio State University Medical Center, Columbus, USA.
| | - Xuzhong Xu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.
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Kelley TM, Bailey DW, Sparks P, Rice R, Caddell E, Currier H, Gallo D. Intercostal Nerve Blockade with Exparel® Results in Lower Opioid Usage during the First 24 Hours after Video-Assisted Thorascopic Surgery. Am Surg 2018. [DOI: 10.1177/000313481808400945] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Liposomal bupivacaine (LipoB) provides prolonged local anesthetic effects and has seen usage in several fields of surgery. We review our experience using LipoB intraoperatively for intercostal nerve blocks after video-assisted throacoscopic surgery (VATS). A retrospective, single-center review was conducted for patients undergoing VATS from August 2012 to December 2014. Patients those who received LipoB as an intercostal nerve block were compared with patients who received blocks with standard bupivacaine. Opiate amounts used within the first six hours and then subsequent 18,48, and 72 hours were converted into morphine equivalents for comparison. Forty-seven patients met inclusion criteria: 21 receiving LipoB intercostal nerve block and 26 controls. Groups were similar for age, diabetes, hypertension, chronic kidney disease, body mass index and American Society of Anesthesiologists scores. The LipoB group had a larger portion of males (P < 0.02). Postoperatively, morphine equivalent usage was significantly less in the LipoB group compared with the standard bupivacaine within the first six hours after surgery (15.62 vs 52.41, P = 0.001) and in the subsequent 18 hours (28.98 vs 65.17, P = 0.01). After the first 24 hours there was not a significant difference in opiate usage between the two groups. There was no difference in length of stay between the two groups. In our study group of VATS patients, an intercostal nerve block with LipoB significantly reduced the usage of postoperative opioids in the first 24 hours only when compared with standard bupivacaine.
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Affiliation(s)
- Thomas M. Kelley
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Daniel W. Bailey
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Preston Sparks
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Robert Rice
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Erin Caddell
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Heather Currier
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Dominic Gallo
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
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Chakravarthy M. Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia? Ann Card Anaesth 2018; 21:225-227. [PMID: 30052206 PMCID: PMC6078036 DOI: 10.4103/aca.aca_56_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
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Sundaramurthi T, Gallagher N, Sterling B. Cancer-Related Acute Pain: A Systematic Review of Evidence-Based Interventions for Putting Evidence Into Practice. Clin J Oncol Nurs 2017; 21:13-30. [DOI: 10.1188/17.cjon.s3.13-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. THE JOURNAL OF PAIN 2016; 17:131-57. [PMID: 26827847 DOI: 10.1016/j.jpain.2015.12.008] [Citation(s) in RCA: 1605] [Impact Index Per Article: 200.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence. PERSPECTIVE This guideline, on the basis of a systematic review of the evidence on postoperative pain management, provides recommendations developed by a multidisciplinary expert panel. Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations.
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Teksoz S, Arikan AE, Soylu S, Erbabacan SE, Ozcan M, Bukey Y. Bupivacaine application reduces post thyroidectomy pain: Cerrahpasa experience. Gland Surg 2016; 5:565-570. [PMID: 28149801 DOI: 10.21037/gs.2016.12.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to evaluate the impact of bupivacaine administration into the surgical field after total thyroidectomy on post-operative pain and analgesic requirement with a double-blind, prospective, clinical and randomized study. METHODS The study was performed between 2010 and 2011. Pain assessment was performed with the visual analog score (VAS). Patients were pre-operatively, randomly divided into two groups to receive either bupivacaine or saline. One group received a 10-mL of bupivacaine solution while the other group was treated with the same volume of 0.9% NaCl through the drain after completion of total thyroidectomy procedure. All patients were anesthetized and operated with the same anesthesia and surgical team. RESULTS Ninety-one patients (20 males) were included in the study. No patient dropped out of the study during the procedures. No mortality was seen. The VAS scores were significantly lower in the bupivacaine administered group at post-operative minute 30 (3.7±3.2 vs. 5±2.9; P=0.03), hour one (3.04±2.4 vs. 4.2±2.8; P=0.04), and hour eight (1.8±2.04 vs. 3.2±2.1; P=0.005). Thirteen patients required analgesia during their hospital stay in the bupivacaine group while this number was twenty-two in the saline group (P=0.005). CONCLUSIONS Local bupivacaine administration into the surgical field after total thyroidectomy reduces pain and analgesic requirement during the hospital stay.
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Affiliation(s)
- Serkan Teksoz
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey
| | - Akif Enes Arikan
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey
| | - Selen Soylu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey
| | - Safak Emre Erbabacan
- Department of Anesthesiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey
| | - Murat Ozcan
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey
| | - Yusuf Bukey
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey
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Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment. Pain Res Manag 2016; 2016:3652726. [PMID: 28018130 PMCID: PMC5149649 DOI: 10.1155/2016/3652726] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/25/2016] [Indexed: 11/17/2022]
Abstract
Context. Postthoracotomy Ipsilateral Shoulder Pain (IPS) is a common and sometimes intractable pain syndrome. IPS is different from chest wall pain in type, origin, and treatments. Various treatments are suggested or applied for it but none of them is regarded as popular accepted effective one. Objectives. To review data and collect all present experiences about postthoracotomy IPS and its management and suggest future research directions. Methods. Search in PubMed database and additional search for specific topics and review them to retrieve relevant articles as data source in a narrative review article. Results. Even in the presence of effective epidural analgesia, ISP is a common cause of severe postthoracotomy pain. The phrenic nerve has an important role in the physiopathology of postthoracotomy ISP. Different treatments have been applied or suggested. Controlling the afferent nociceptive signals conveyed by the phrenic nerve at various levels—from peripheral branches on the diaphragm to its entrance in the cervical spine—could be of therapeutic value. Despite potential concerns about safety, intrapleural or phrenic nerve blocks are tolerated well, at least in a selected group of patient. Conclusion. Further researches could be directed on selective sensory block and motor function preservation of the phrenic nerve. However, the safety and efficacy of temporary loss of phrenic nerve function and intrapleural local anesthetics should be assessed.
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Wu CF, Hsieh MJ, Liu HP, Gonzalez-Rivas D, Liu YH, Wu YC, Chao YK, Wu CY. Management of post-operative pain by placement of an intraoperative intercostal catheter after single port video-assisted thoracoscopic surgery: a propensity-score matched study. J Thorac Dis 2016; 8:1087-93. [PMID: 27293824 DOI: 10.21037/jtd.2016.04.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The establishment of a golden standard for post-operative analgesia after thoracic surgery remains an unresolved issue. Benefiting from the rapid development of single port video-assisted thoracoscopic surgery (VATS), a good candidate for the alleviation of patients' pain is the placement of an intercostal catheter (ICC) safely after uniport VATS. We hypothesized that continual infusion through ICC could provide effective analgesia for patients with only one wound and we evaluate its postoperative analgesic function in uniport VATS patients with or without intercostal nerve blockade. METHODS Since March 2014, 235 patients received various kinds of single port VATS. We identified 50 patients who received single port VATS with intercostal nerve blockade and retrospectively compared them with a group of patients who had received single port VATS without intercostal nerve blockade. The operative time, post operation day 0, 1, 2, 3 and discharge day pain score, narcotic requirements, drainage duration and post-operative hospital stay were collected. In order to establish a well-balanced cohort study, we also used propensity scores matching (1:1) to compare the short term clinical outcome in two groups. RESULTS No operative deaths occurred in this study. The uniport VATS with intercostal nerve blockade group was associated with less post operation day 0 and day 1 pain score, and narcotic requirements in our cohort study (P<0.001, <0.001, and 0.003). After propensity scores matching, there were 50 patients in each group. Mean day 0 and day 1, day 2, day 3 pain score, drainage duration, post-operative hospital stay, and narcotic requirements were smaller in uniport VATS with intercostal nerve blockade (P<0.001, <0.001, 0.038, 0.007, 0.02, 0.042, and 0.003). CONCLUSIONS In conclusion, in patients post single port VATS, continual intercostal nerve block with levobupivacaine infusion appears to be a safe, effective and promising technique in our study, associated with a shorter hospital stay and less post-operative pain. Further prospective trials are needed to determine the long term outcomes.
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Affiliation(s)
- Ching-Feng Wu
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Ming-Ju Hsieh
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Hung-Pin Liu
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Diego Gonzalez-Rivas
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Yun-Hen Liu
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Yi-Cheng Wu
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Yin-Kai Chao
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Ching-Yang Wu
- 1 Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan ; 2 Chang Gung University, Department of Anesthesia, Chang Gung Memorial Hospital, Linkou, Taiwan ; 3 Department of Thoracic Surgery, Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
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Yang HC, Lee JY, Ahn S, Cho S, Kim K, Jheon S, Kim JS. Pain control of thoracoscopic major pulmonary resection: is pre-emptive local bupivacaine injection able to replace the intravenous patient controlled analgesia? J Thorac Dis 2015; 7:1960-9. [PMID: 26716034 DOI: 10.3978/j.issn.2072-1439.2015.11.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this open-label, non-inferiority trial was to evaluate whether pre-emptive local bupivacaine injection (PLBI) can replace intravenous patient controlled analgesia (IV PCA) in video-assisted thoracic surgery (VATS) major pulmonary resection. METHODS A total of 86 patients scheduled for VATS segmentectomy/lobectomy were randomly assigned into two groups. The PLBI group (n=42) received 0.5% bupivacaine wound infiltration before skin incision, and the IV PCA group (n=44) received a continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. Visual analogue scale (VAS; range, 0-10) was measured as the primary endpoint. The secondary endpoint was an additional use of analgesics and drug induced side effects. RESULTS Both groups showed no difference in terms of age, sex, disease entity, operation time, chest tube indwelling time, and hospital stay. Serial pain scores between the PLBI and IV PCA groups demonstrated no statistical differences (non-inferiority margin; ΔVAS =1.0) (Recovery room: 8.3±2.1 vs. 8.5±1.7; Day 0: 5.1±1.6 vs. 5.2±1.4; Day 1: 3.5±1.6 vs. 3.3±1.2; Day 2: 2.7±1.3 vs. 2.5±1.2; Day 3: 2.3±1.3 vs. 2.1±1.5; 1 week after discharge: 3.0±1.7 vs. 2.8±1.5; 1 month: 1.9±1.2 vs. 2.3±1.4 and 2 months: 1.5±1.2 vs. 1.3±1.2; 95% confidential interval (CI) of ΔVAS <1.0; P>0.05). The mean one-additional usage of IV analgesics was needed in the PLBI group (3.3±2.1 vs. 2.3±1.3; P=0.03). The occurrence of nausea/vomiting was higher in the IV PCA group (12.5% vs. 38.9%; P=0.026) and 41.7% of IV PCA patients experienced drug side effects that required IV PCA removal within postoperative day (POD) 1. CONCLUSIONS PLBI is a simple, safe, effective, and economical method, which is not inferior to IV PCA in VATS major pulmonary resection.
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Affiliation(s)
- Hee Chul Yang
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ja-Young Lee
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soyeon Ahn
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sukki Cho
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghoon Jheon
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Sung Kim
- 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Hopkins KG, Hoffman LA, Dabbs ADV, Ferson PF, King L, Dudjak LA, Zullo TG, Rosenzweig MQ. Postthoracotomy Pain Syndrome Following Surgery for Lung Cancer: Symptoms and Impact on Quality of Life. J Adv Pract Oncol 2015; 6:121-32. [PMID: 26649245 PMCID: PMC4601892 DOI: 10.6004/jadpro.2015.6.2.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described. We therefore examined the symptoms and quality of life (QOL) of patients with and without PTPS who underwent a standard thoracotomy (n = 43) or minimally invasive surgery (n = 54). Patients in this prospective, cross-sectional study completed questionnaires to assess pain (McGill Pain Questionnaire), neuropathic symptoms (Neuropathic Symptom Questionnaire), symptom distress (Symptom Distress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment Cancer Therapy–Lung). Excepting younger age (p = .009), no demographic or surgical characteristic differentiated patients with and without PTPS. Patients with PTPS described discomfort as pain only (15.1%), neuropathic symptoms only (30.2%) or pain and neuropathic symptoms (54.7%). Scores differed between patients with and without PTPS for symptom distress (p < .001), anxiety and depression (p < .001), and QOL (p = .009), with higher distress associated with PTPS. Despite new surgical techniques, PTPS remains common and results in considerable distress. A focused assessment is needed to identify all experiencing this condition, with referral to pain management specialists if symptoms persist.
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Affiliation(s)
- Kathleen G Hopkins
- Carlow University College of Health and Wellness, Department of Nursing, Pittsburgh, Pennsylvania
| | - Leslie A Hoffman
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | | | - Peter F Ferson
- University of Pittsburgh School of Medicine, Department of Cardiothoracic Surgery, Pittsburgh, Pennsylvania
| | - Linda King
- University of Pittsburgh School of Medicine, Department of General Internal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania
| | - Linda A Dudjak
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Thomas G Zullo
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: a systematic review. Eur J Cardiothorac Surg 2013; 45:959-66. [DOI: 10.1093/ejcts/ezt525] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morris SA, Izatt MT, Adam CJ, Labrom RD, Askin GN. Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis. SCOLIOSIS 2013; 8:18. [PMID: 24238280 PMCID: PMC3842798 DOI: 10.1186/1748-7161-8-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/07/2013] [Indexed: 12/02/2022]
Abstract
Background Thoracoscopic anterior scoliosis instrumentation is a safe and viable surgical option for corrective fusion of progressive adolescent idiopathic scoliosis (AIS) and has been performed at our centre on 205 patients since 2000. However, there is a paucity of literature reporting on or examining optimum methods of analgesia following this type of surgery. A retrospective study was designed to present the authors’ technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime. Methods Records for 32 patients who underwent thoracoscopic anterior correction for AIS were reviewed. All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Patient’s perceptions of their pain control was measured using the visual analogue pain scale scores which were recorded before and after local anaesthetic administration and the quantity and time of day that any other analgesia was taken, were also recorded. Results 28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method. Conclusions Local anaesthetic administration via an intrapleural catheter is a safe and effective method of analgesia following thoracoscopic anterior scoliosis correction. Post-operative pain following anterior thoracic scoliosis surgery can be reduced to ‘mild’ levels by combined analgesia regimes.
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Affiliation(s)
| | - Maree T Izatt
- QUT/Mater Paediatric Spine Research Group, Queensland University of Technology and Mater Research, Level 2, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
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Hitt JM, Demmy TL. Managing pain after thoracic surgery. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY It is generally accepted that thoracic surgery for lung cancer produces some of the most intense and difficult perioperative and chronic pain challenges. In the acute period of recovery, practitioners must optimize patient comfort and pulmonary function. This can be achieved through a combination of systemic treatment and regional analgesic options. Thoracic surgery also causes relatively high levels of persistent postsurgical pain. Many of the cases of persistent pain have a clear neuropathic pain mechanism, but a significant number of cases do not. While persistent pain correlates directly with the extent of operative trauma, even video-assisted thoracoscopic surgery approaches can cause chronic pain. Persistent pain is treated with medical and interventional therapies customized to an individual patient’s complaints and medication tolerance.
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Affiliation(s)
- James M Hitt
- Roswell Park Cancer Institute, Buffalo, NY, USA
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
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20
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Hopkins KG, Rosenzweig M. Post-thoracotomy pain syndrome: assessment and intervention. Clin J Oncol Nurs 2013; 16:365-70. [PMID: 22842687 DOI: 10.1188/12.cjon.365-370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgery is a cornerstone of treatment in early-stage non-small cell lung cancer. Chronic postoperative thoracotomy pain, post-thoracotomy pain syndrome (PTPS), is a condition occurring in 50% of postsurgical patients with lung cancer and is largely unrecognized. This article examines the diagnosis and treatment of PTPS to assist oncology nurses in providing better care to this patient population. Post-thoracotomy pain in patients with lung cancer may be under-reported and undertreated. Causes from the thoracotomy can be trauma and compression to the intercoastal nerves, fractured and compressed ribs, inflammation of the chest muscles, atrophy of chest muscles, or scar tissue rubbing. This article examines the diagnosis and treatment of PTPS to assist oncology nurses in providing better care to this patient population. If left untreated, chronic pain can have a deleterious effect on patients' recovery and overall well-being. Oncology nurses should be aware of the signs and symptoms of PTPS so that more patients are diagnosed and choose to seek treatment.
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Yendamuri S, Demmy TL. Lobectomy for patients with limited lung function. Semin Thorac Cardiovasc Surg 2012; 23:191-5. [PMID: 22172355 DOI: 10.1053/j.semtcvs.2011.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2011] [Indexed: 11/11/2022]
Abstract
Increasingly, lung cancer is being diagnosed at an early stage. This trend is likely to increase with computerized tomographic screening as a result of the findings of the National Lung Screening Trial. Even in 2011, anatomical lobectomy is the gold standard for curative resection for early lung cancer. However, a significant proportion of patients with early lung cancer have limited lung function that places them at higher risk of complications from lobectomy. This article reviews the existing data for lobectomy in patients with limited lung function.
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Affiliation(s)
- Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA
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Kaplowitz J, Papadakos PJ. Acute Pain Management for Video-Assisted Thoracoscopic Surgery: An Update. J Cardiothorac Vasc Anesth 2012; 26:312-21. [DOI: 10.1053/j.jvca.2011.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Indexed: 11/11/2022]
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Regional anesthetic techniques for video-assisted thoracoscopic surgery. Reg Anesth Pain Med 2011; 36:416. [PMID: 21697698 DOI: 10.1097/aap.0b013e318220f19e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Neustein SM, McCormick PJ. Postoperative analgesia after minimally invasive thoracoscopy: What should we do? Can J Anaesth 2011; 58:423-5, 425-7. [DOI: 10.1007/s12630-011-9475-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/14/2011] [Indexed: 11/25/2022] Open
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Current World Literature. Curr Opin Anaesthesiol 2010; 23:116-20. [DOI: 10.1097/aco.0b013e3283357df6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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