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Fan CY, Lin CW, Sung CW, Huang EPC. Therapeutic potential of physical stabilization in VATS pain control: a randomized controlled trial. Updates Surg 2024:10.1007/s13304-024-01999-w. [PMID: 39277837 DOI: 10.1007/s13304-024-01999-w] [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: 03/17/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
Video-assisted thoracoscopic surgery (VATS) has been widely used for low invasiveness and shorter recovery time. However, patients receiving VATS still experienced moderate-to-severe pain even under both regional and systemic analgesia. Little is known on the effect of non-pharmaceutical method with physical stabilization for post-VATS pain control. The study aims to investigate the feasibility of physical stabilization as a surrogate method for pain control. The single-blinded, randomized-controlled trial recruited the patients into physical stabilization group and standard care group after VATS. The patients in the intervention group tied a thoracic belt for all day, while the control group did not. Both groups had intravenous patient-controlled analgesia (IVPCA) and on-demand oral analgesics. The primary outcome was the visual analogue scale for pain at the 6th, 24th and 48th hour post-VATS and at the hospital discharge. There were 18 patients assigned to the interventional group and 18 patients assigned to the control group. Four patients in the control group were dropped out from the study. Physical stabilization was found to enhance the analgesic effect post-operative 24-48 h compared to standard care (Difference of VAS: 1.11 ± 0.68 v.s. 0.5 ± 0.86, p = 0.031). It had no effect on the dose of IVPCA or the use of oral analgesic agents. No complications direct to the thoracic belt or adverse outcome from the surgery were found in the study. Physical stabilization with thoracic belt to patients receiving VATS benefits to pain control, especially between the 24th and 48th hour post-VATS. Clinical Trial Registry number: NCT04735614.
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Affiliation(s)
- Cheng-Yi Fan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
| | - Chi-Wei Lin
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Zhang L, Shen J, Luo Y. The impact of paravertebral nerve blockade on postoperative surgical site wound pain management in patients undergoing video-assisted thoracoscopic surgery for pulmonary carcinoma resection. Int Wound J 2024; 21:e14608. [PMID: 38151912 PMCID: PMC10961871 DOI: 10.1111/iwj.14608] [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: 11/13/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
Management of postoperative pain is of vital importance for patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) for Pulmonary Carcinoma Resection. The study evaluates the impact of Paravertebral Nerve Blockade (PNB) in conjunction with general anaesthesia on postoperative pain relief, as compared with general anaesthesia alone. A retrospective analysis was carried out from May 2020 to May 2023, involving 100 patients with pathologically confirmed pulmonary carcinoma. The patients were divided into two groups: a control group that received general anaesthesia and an observation group that received a combination of general anaesthesia and PNB. The intensity of postoperative pain was assessed at various time intervals using the visual analogue scale (VAS), while the effectiveness of patient-controlled analgesia was also evaluated. Additionally, the study examined the incidence rates of chronic pain in the postoperative period. Statistical analysis was performed using IBM SPSS version 27.0. Significant reductions in VAS scores for both resting and cough-induced pain were observed in the observation group at 2 and 6 h post-operation (p < 0.01). However, the difference diminished over time. The observation group had fewer patient-controlled analgesia activations and required lower dosages of hydromorphone at both 24- and 48-h post-operation. The incidence of chronic pain was also significantly lower in the observation group (24.00%) compared with the control group (54.00%) (p < 0.01). PNB, when administered in combination with general anaesthesia, significantly reduces immediate postoperative pain and the requirement for additional analgesics in patients undergoing VATS for pulmonary carcinoma resection. The effect diminishes over time but has a lasting impact on reducing the incidence of chronic postoperative pain.
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Affiliation(s)
- Liyun Zhang
- Department of Anesthesiology, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Jie Shen
- Department of Anesthesiology, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yan Luo
- Department of Anesthesiology, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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Hui H, Miao H, Qiu F, Lin Y, Li H, Zhang Y, Jiang B. Adjunctive dexamethasone palmitate use for intercostal nerve block after video-assisted thoracoscopic surgery: A prospective, randomized control trial. Heliyon 2023; 9:e19156. [PMID: 37662806 PMCID: PMC10474424 DOI: 10.1016/j.heliyon.2023.e19156] [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: 02/14/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives The efficacy of dexamethasone palmitate in extending durations of local anesthetic blocks is uncertain. In a randomized, double-blind study of patients undergoing video-assisted thoracoscopic surgery, we tested whether intravenous or perineural dexamethasone palmitate caused prolonged analgesia after intercostal nerve block. Methods A total of 90 patients subjected to video-assisted thoracoscopic surgery between May and December 2022 were randomly assigned to one of three intercostal nerve blocks study arms (n = 30 each), requiring the addition of 0.5% ropivacaine (23 ml) as follows: controls (C group), 2 ml saline; IV-DXP group, 2 ml saline + 2 ml (8 mg) intravenous dexamethasone palmitate; and PN-DXP group, 2 ml (8 mg) perineural dexamethasone palmitate. Time to first postoperative remedial analgesia served as primary outcome measure. Secondary endpoints included postoperative opioid consumption, pain scores by Visual Analog Scale, analgesia satisfaction, and related adverse effects. Results Compared with controls or the IV-DXP group, time to first postoperative remedial analgesia was longer and postoperative opioid consumption for rescue analgesia was lower in the PN-DXP group (p < 0.01). Similarly, the Visual Analog Scale scores in patients at 8, 12, 18, and 24 h postoperatively were lower in the PN-DXP group than in controls and the IV-DXP group (p < 0.01). Patient satisfaction was statistically lower in the PN-DXP group, compared with either the control or IV-DXP group (p < 0.05). Clinically, the three groups did not differ significantly in occurrences of adverse effects during the 48-h postoperative monitoring period (p > 0.05). Conclusions Perineural dexamethasone palmitate is a promising adjunct to ropivacaine intercostal nerve block by prolonging analgesia with almost no related adverse effects.
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Affiliation(s)
| | | | | | - Yangui Lin
- Department of Thoracic Cardiovascular Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Huaming Li
- Department of Thoracic Cardiovascular Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yiqian Zhang
- Department of Thoracic Cardiovascular Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Bo Jiang
- Department of Thoracic Cardiovascular Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
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Lin WY, Lin FS, Shih CC, Sung YJ, Chen AY, Piao YC, Chen JS, Cheng YJ. Comparisons on the intraoperative desaturation and postoperative outcomes in non-intubated video-assisted thoracic surgery with supraglottic airway devices or high-flow nasal oxygen: A retrospective study. J Formos Med Assoc 2023; 122:309-316. [PMID: 36463081 DOI: 10.1016/j.jfma.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Few studies have compared intraoperative oxygenation and perioperative outcomes between non-intubated video-assisted thoracic surgery (NIVATS) with supraglottic airway devices (SADs) and NIVATS with high flow nasal oxygenation (HFNO). The aim of this retrospective study was to compare the intraoperative desaturation rate and postoperative outcomes between NIVATS with SADs and NIVATS with HFNO. METHODS Data regarding NIVATS performed for lung cancer from January 2020 to December 2021 were collected. Intraoperative anesthetic results, post-anesthetic adverse effects, and surgical outcomes for patients who received SAD or HFNO were analyzed using propensity score-matched and unmatched analysis. RESULTS In total, 199 patients with i-gel™ and 95 patients with HFNO were included. Significantly more female patients (91.6 vs. 82.4%, p = 0.0378) and fewer wedge resections (78.9 vs. 85.4%, p = 0.0258) were observed in the HFNO group. Among 250 patients who underwent NIVATS wedge resections under total intravenous anesthesia, those who received HFNO had a significantly higher desaturation event rate (19.8% vs. 7.9% in i-gel™ group; p = 0.0063), lower nadir SPO2 (94.0% vs. 96.1% in i-gel™ group; p = 0.0012), and longer hospitalization (4.0 ± 0.8 vs. 3.6 ± 0.6 in i-gel™ group; p < 0.0001). However, propensity score matching analysis revealed no significant between-group difference in the desaturation rate. A log-rank test revealed that smoking (p = 0.0005) and HFNO (p = 0.0074) were associated with intraoperative desaturation. CONCLUSION The rate of SAD use in NIVATS was twice the rate of HFNO use, especially for wedge resections. There is uncertain airway patency and limited flow through HFNO during one-lung ventilation, whereas SADs like i-gel™ presented a significantly less intraoperative desaturation rate over time and similar postoperative outcomes.
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Affiliation(s)
- Wen-Ying Lin
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Feng-Sheng Lin
- Department of Anesthesiology, National Taiwan University Hospital, 7, Chung-Shan S Rd, Taipei City 10002, Taiwan
| | - Chung-Chih Shih
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Yi-Jung Sung
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - An-Yu Chen
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Yu-Chin Piao
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan.
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Ditlev M, Loentoft E, Hölmich LR. Breast augmentation under local anesthesia with intercostal blocks and light sedation. J Plast Surg Hand Surg 2023; 57:271-278. [PMID: 35510744 DOI: 10.1080/2000656x.2022.2069789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study of breast augmentations performed under local anesthesia with intercostal blocks and light sedation describes the outcomes and evaluates benefits and complications. METHOD From December 2005 until August 2019, 335 women consecutively underwent bilateral breast augmentation procedures. The anesthetic protocol consisted of an initial intravenous bolus of 1 mg midazolam and 0.25 mg alfentanil preoperatively. In 2017, this was changed to 2-4 mg midazolam intramuscularly, 1 mg midazolam intravenously, and 2.5 µg sufentanil intravenously. Intercostal blocks were injected at the midaxillary line into the intercostal spaces two to seven. The operating field was infiltrated with tumescent local anesthesia. Retrospective data extraction from patients' medical charts was done, registering demographics, dosage of anesthesia, surgical characteristics, complications, and reoperation rates. RESULTS Two hundred and eighty-one women underwent primary augmentation and 54 had implant replacement. The most common complications included suboptimal cosmetic results, asymmetry, and healing-related problems. The overall rate of reoperation was 16.1% within an average follow-up period of 2 years, ranging from 0 to 12.5 years. The majority of the reoperations were due to cosmetic reasons. The change in anesthetic regime was associated with a significantly (p < 0.0001) decreased need for supplementary medication with no increased risk of complications. CONCLUSION Breast augmentations in local anesthesia with intercostal blocks and light sedation can be performed safely and can serve as an alternative to procedures in general anesthesia.
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Affiliation(s)
- Martine Ditlev
- Plastic Surgery Clinic, Erik Loentoft, Odense, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Erik Loentoft
- Plastic Surgery Clinic, Erik Loentoft, Odense, Denmark
| | - Lisbet R Hölmich
- Department of Plastic Surgery, Copenhagen University, Herlev and Gentofte, Copenhagen, Denmark
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Ji K, Wang Z, Zheng X, Wei H, Shi Y, Qian P. Application of ultrasound-guided paravertebral nerve block in preemptive analgesia of thoracic surgery. Panminerva Med 2022; 64:584-585. [PMID: 33307641 DOI: 10.23736/s0031-0808.20.04215-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Kemin Ji
- Department of Anesthesiology, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, China
| | - Zhibo Wang
- Department of Anesthesiology, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, China
| | - Xiaoyu Zheng
- Department of Anesthesiology, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, China
| | - Huaying Wei
- Department of Anesthesiology, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, China
| | - Yugang Shi
- Department of Anesthesiology, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, China
| | - Ping Qian
- Department of Anesthesiology, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, China -
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7
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Comparison of intercostal nerve blockage versus local anesthesia for tube thoracostomy insertion; a randomised controlled trial. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Sandeep B, Huang X, Li Y, Xiong D, Zhu B, Xiao Z. A comparison of regional anesthesia techniques in patients undergoing video-assisted thoracic surgery: A network meta-analysis. Int J Surg 2022; 105:106840. [PMID: 36030040 DOI: 10.1016/j.ijsu.2022.106840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain control remains challenging in patients undergoing video-assisted thoracoscopic surgery (VATS). This study aimed to investigate the relative efficacy of different regional anesthesia interventions for VATS using a Network Meta analysis (NMA). METHODS A literature search was conducted for NMA using Pubmed, The Cochrane Library, Embase, and the Web of Science databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of different regional analgesia techniques from inception to February 2022. The primary outcome was opioid consumption during the first 24 h postoperatively. The secondary outcomes were morphine consumption at 48 h postoperatively, pain intensity, postoperative nausea and vomiting, and hospital length of stay. Pain scores at two different intervals from different regional analgesia techniques were measured and investigated in this NMA. RESULTS A total of 38 RCTs (2224 patients) were included. Two studies compared three arm interventions of intercostal nerve block (ICNB) vs. thoracic paravertebral block (TPVB) vs. erector spinae plane block (ESPB) in intravenous morphine consumption at 24 h and 48 h postoperatively, and showed patients who received TPVB had less demand for morphine than ICNB and ESPB (P = 0.001, P = 0.001). For resting pain scores at 24 h postoperatively, ESPB was superior to serratus anterior plane block (SAPB) (P = 0.01), and TPVB provided effective analgesia compared to ICNB, retrolaminar block (RLB), and ESPB (P = 0.05, P = 0.01, P = 0.03). Similarly, pain scores at rest at 48 h, SAPB and TPVB showed the best results (P = 0.04, P = 0.001, P = 0.01) compared with local infiltration analgesia (LIA), ICNB, RLB, and ESPB. Additionally, pain scores at coughing at 24 h and 48 h, TPVB showed superior results compared with RLB,ESPB(P = 0.02, P = 0.02, P = 0.03). SAPB was superior to LIA in reducing the incidence of postoperative nausea and vomiting (P = 0.04). CONCLUSION In regional anaesthesia, TPVB is a better option than other analgesic methods, and its combination with other methods can be beneficial. However, our findings can only provide objective evidence. Clinicians should choose the treatment course based on the individual patient's condition and clinical situation.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China.
| | - Yuan Li
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Dan Xiong
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Bo Zhu
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
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Gondar MB, Fernandes M, Mondragon P, Hagerman A, Magnusson L. Intercostal nerve block is effective in open biopsies of the anterior mediastinal region: Case report and review. Int J Surg Case Rep 2022; 97:107461. [PMID: 35907298 PMCID: PMC9403297 DOI: 10.1016/j.ijscr.2022.107461] [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: 06/25/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Anterior mediastinal masses are rare conditions that can become symptomatic through compression of the airways and vascular structures. Fatal or severe complications can occur during anesthesia and surgery. With this review we aim to describe the state of the art in peri-anesthetic management of mediastinal tumors, which we illustrate with a clinical case. PRESENTATION OF CASE We report a case of a young female patient suffering from a large anterior mediastinal mass that underwent an open biopsy after intercostal nerve blocks (INB) in six consecutive right intercostal spaces (2nd to 7th). A right anterior mediastinotomy was performed and an excellent analgesic effect was achieved. The patient was awake and did not experience significant pain or cough, having received paracetamol 1 g and returned home later in the day. The diagnosis of non-Hodgkin's lymphoma was later confirmed. DISCUSSION Our review showed that anesthesia for mediastinal masses' resection or open biopsy is rare and prone to severe complications. Such complications are more important in children, patients in supine position, under general anesthesia and already symptomatic prior to the procedure. INB presents some advantages against paravertebral block (PVB) and thoracic epidural anesthesia (TEA), is easier to reproduce and has a shorter learning curve. Airway stenting with a rigid bronchoscope can be an alternative. CONCLUSION Multilevel medial axillary line INBs are safer and easier to reproduce than PVB, have less hemodynamic repercussion than TEA and can, therefore, be preferable for open anterior mediastinal biopsies or small masses resection.
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Affiliation(s)
- Marina Brito Gondar
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland,Département de Médecine Aiguë, Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Genève, Switzerland,Corresponding author at: Department of Anesthesiology, Hôpital fribourgeois, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Switzerland.
| | - Mariana Fernandes
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Pablo Mondragon
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland,Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Andres Hagerman
- Département de Médecine Aiguë, Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Lennart Magnusson
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland,Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
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Szamborski M, Janc J, Rosińczuk J, Janc JJ, Leśnik P, Łysenko L. Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8696. [PMID: 35886547 PMCID: PMC9320164 DOI: 10.3390/ijerph19148696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.
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Affiliation(s)
- Marek Szamborski
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | | | - Patrycja Leśnik
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Lidia Łysenko
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-529 Wroclaw, Poland;
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11
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Feng M, Wang L, Sun J, Chen Z, Fu J, Liu D, Zhang R, Li Y, Zhang Y, Zhang H, Zhang W, Feng C. Thoracic Paravertebral Block Combined with General Anaesthesia or General Anaesthesia Alone for Thoracoscopic Lung Adenocarcinoma Surgery: A Retrospective Study. Cancer Manag Res 2022; 14:953-965. [PMID: 35264885 PMCID: PMC8901418 DOI: 10.2147/cmar.s346285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anaesthesia or general anaesthesia alone for thoracoscopic lung adenocarcinoma surgery, and to provide new thoughts for improving the clinical outcomes. Methods This was a retrospective study. Data were retrieved for 195 patients with lung adenocarcinoma undergoing elective radical lobectomy via video-assisted thoracoscopy between January 2018 and August 2019 in The Second Hospital of Shandong University, including 86 patients who received thoracic paravertebral block (TPVB) combined with general anaesthesia (group TG), and 109 patients who received general anaesthesia alone (group GA). All patients were given self-controlled intravenous analgesia pump for 48 h after surgery. The primary outcome was the recurrence-free survival 2 years postoperatively (the time between surgery and the earliest date of recurrence, metastasis or lung cancer-cause death). The secondary outcomes included the average numeric rating scale (NRS) scores within 48 h postoperatively, the first time of postoperative ambulation, duration of chest tube drainage, length of postoperative hospitalization, perioperative opioid consumption and the postoperative side effects. Results There were no statistical differences in the recurrence-free survival 2 years postoperatively between groups (Multivariate hazard ratio 0.706, 95% CI 0.126–3.941, P=0.691). The average NRS scores within 48 h postoperatively were significantly lower in group TG (P<0.05). The first time of postoperative ambulation, duration of chest tube drainage, and length of postoperative hospitalization in group TG were significantly reduced (P<0.05). Opioid consumption was significantly decreased in group TG (P<0.01). Finally, the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group TG (P<0.05). Conclusion TPVB for thoracoscopic lung adenocarcinoma surgery did not improve the recurrence-free survival 2 years postoperatively compared with general anaesthesia alone, but it significantly enhanced the postoperative analgesia effect, reduced opioid consumption as well as side effects, and accelerated postoperative early recovery. Clinical Trial Registration Number The Chinese Clinical Trial Registry (ChiCTR-2100050454).
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Affiliation(s)
- Man Feng
- Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, The third Affiliated Hospital of Shandong First Medical University, Jinan, 250000, People’s Republic of China
| | - Lulu Wang
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jing Sun
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Zheping Chen
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jia Fu
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Dongyi Liu
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Rumeng Zhang
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Youqin Li
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Yan Zhang
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - He Zhang
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Weiquan Zhang
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Chang Feng
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- Correspondence: Chang Feng, Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +86 17660085521, Email
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12
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Xu Q, Mo X, Xiong J, Zhang Y. Case Report: Discontinuous Spontaneous Ventilating Anesthesia for McKeown Esophagectomy by Laryngeal Mask: A Case Series-A Novel Approach of Discontinuous Spontaneous Ventilating Anesthesia for Esophagectomy. Front Surg 2021; 8:783859. [PMID: 34957206 PMCID: PMC8696255 DOI: 10.3389/fsurg.2021.783859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Double lumen endobronchial ventilation in McKeown esophagectomy is common for esophageal cancer. In spite of most patients could be extubated immediately after surgery under adequate multimodal analgesia, still some patients require extended mechanical ventilation or airway support post-surgery because of pain or difficult respiration. The present study reported a novel challenge for McKeown esophagectomy with discontinuous spontaneous ventilating anesthesia by the laryngeal mask. Three esophageal cancer patients underwent McKeown esophagectomy under discontinuous spontaneous ventilating anesthesia with local and regional analgesia and appropriate sedation. Two of them were accomplished under non-intubated video-assisted thoracoscopic surgery (NIVATS), and then, the abdominal and neck surgery was managed under laryngeal mask airway with appropriate muscle relaxation. One patient was endured high PetCO2 level, and converted to regular double lumen endobronchial intubation for safety. However, from the two successful cases, we still proved that the discontinuous spontaneous ventilating anesthesia achieved the same anesthetic effect as bronchial intubation under general anesthesia for McKeown esophagectomy, which reduced the postoperative pharyngeal discomfort, might be beneficial to the patients for enhanced recovery after surgery (ERAS).
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Affiliation(s)
- Qiaoqiao Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Xuan Mo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Juan Xiong
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Yi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
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13
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Guerra-Londono CE, Privorotskiy A, Cozowicz C, Hicklen RS, Memtsoudis SG, Mariano ER, Cata JP. Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2133394. [PMID: 34779845 PMCID: PMC8593761 DOI: 10.1001/jamanetworkopen.2021.33394] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The use of intercostal nerve block (ICNB) analgesia with local anesthesia is common in thoracic surgery. However, the benefits and safety of ICNB among adult patients undergoing surgery is unknown. OBJECTIVE To evaluate the analgesic benefits and safety of ICNB among adults undergoing thoracic surgery. DATA SOURCES A systematic search was performed in Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library databases using terms for ICNB and thoracic surgery (including thoracic surgery, thoracoscopy, thoracotomy, nerve block, intercostal nerves). The search and results were not limited by date, with the last search conducted on July 24, 2020. STUDY SELECTION Selected studies were experimental or observational and included adult patients undergoing cardiothoracic surgery in which ICNB was administered with local anesthesia via single injection, continuous infusion, or a combination of both techniques in at least 1 group of patients. For comparison with ICNB, studies that examined systemic analgesia and different forms of regional analgesia (such as thoracic epidural analgesia [TEA], paravertebral block [PVB], and other techniques) were included. These criteria were applied independently by 2 authors, and discrepancies were resolved by consensus. A total of 694 records were selected for screening. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data including patient characteristics, type of surgery, intervention analgesia, comparison analgesia, and primary and secondary outcomes were extracted independently by 3 authors. Synthesis was performed using a fixed-effects model. MAIN OUTCOMES AND MEASURES The coprimary outcomes were postoperative pain intensity (measured as the worst static or dynamic pain using a validated 10-point scale, with 0 indicating no pain and 10 indicating severe pain) and opioid consumption (measured in morphine milligram equivalents [MMEs]) at prespecified intervals (0-6 hours, 7-24 hours, 25-48 hours, 49-72 hours, and >72 hours). Clinically relevant analgesia was defined as a 1-point or greater difference in pain intensity score at any interval. Secondary outcomes included 30-day postoperative complications and pulmonary function. RESULTS Of 694 records screened, 608 were excluded based on prespecified exclusion criteria. The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded. All of the 66 remaining studies (5184 patients; mean [SD] age, 53.9 [10.2] years; approximately 59% men and 41% women) were included in the qualitative analysis, and 59 studies (3325 patients) that provided data for at least 1 outcome were included in the quantitative meta-analysis. Experimental studies had a high risk of bias in multiple domains, including allocation concealment, blinding of participants and personnel, and blinding of outcome assessors. Marked differences (eg, crossover studies, timing of the intervention [intraoperative vs postoperative], blinding, and type of control group) were observed in the design and implementation of studies. The use of ICNB vs systemic analgesia was associated with lower static pain (0-6 hours after surgery: mean score difference, -1.40 points [95% CI, -1.46 to -1.33 points]; 7-24 hours after surgery: mean score difference, -1.27 points [95% CI, -1.40 to -1.13 points]) and lower dynamic pain (0-6 hours after surgery: mean score difference, -1.66 points [95% CI, -1.90 to -1.41 points]; 7-24 hours after surgery: mean score difference, -1.43 points [95% CI, -1.70 to -1.17 points]). Intercostal nerve block analgesia was noninferior to TEA (mean score difference in worst dynamic panic at 7-24 hours after surgery: 0.79 points; 95% CI, 0.28-1.29 points) and marginally inferior to PVB (mean score difference in worst dynamic pain at 7-24 hours after surgery: 1.29 points; 95% CI, 1.16 to 1.41 points). The largest opioid-sparing effect of ICNB vs systemic analgesia occurred at 48 hours after surgery (mean difference, -10.97 MMEs; 95% CI, -12.92 to -9.02 MMEs). The use of ICNB was associated with higher MME values compared with TEA (eg, 48 hours after surgery: mean difference, 48.31 MMEs; 95% CI, 36.11-60.52 MMEs) and PVB (eg, 48 hours after surgery: mean difference, 3.87 MMEs; 95% CI, 2.59-5.15 MMEs). CONCLUSIONS AND RELEVANCE In this study, single-injection ICNB was associated with a reduction in pain during the first 24 hours after thoracic surgery and was clinically noninferior to TEA or PVB. Intercostal nerve block analgesia had opioid-sparing effects; however, TEA and PVB were associated with larger decreases in postoperative MMEs, suggesting that ICNB may be most beneficial for cases in which TEA and PVB are not indicated.
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Affiliation(s)
- Carlos E. Guerra-Londono
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, University of Texas, Houston
| | | | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Rachel S. Hicklen
- Research Medical Library, MD Anderson Cancer Center, University of Texas, Houston
| | | | - Edward R. Mariano
- Department of Anesthesia, School of Medicine, Stanford University, Stanford, California
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, University of Texas, Houston
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
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14
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Huan S, Deng Y, Wang J, Ji Y, Yin G. Efficacy and safety of paravertebral block versus intercostal nerve block in thoracic surgery and breast surgery: A systematic review and meta-analysis. PLoS One 2020; 15:e0237363. [PMID: 33017425 PMCID: PMC7535861 DOI: 10.1371/journal.pone.0237363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. METHODS The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. RESULTS A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). CONCLUSION Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.
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Affiliation(s)
- Sheng Huan
- Nanjing University of Chinese Medicine, Nanjing, Jangsu, China
| | - Youming Deng
- Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China
| | - Jia Wang
- Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China
| | - Yihao Ji
- Nanjing University of Chinese Medicine, Nanjing, Jangsu, China.,Department of Critical Medicine, The Second Hospital of Nanjing, Nanjing, Jangsu, China
| | - Guoping Yin
- Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China
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15
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Liu L, Wu W, Gong L, Zhang M. Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection. J Cardiothorac Surg 2020; 15:285. [PMID: 33004053 PMCID: PMC7528247 DOI: 10.1186/s13019-020-01321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave’s syndrome (BS), is rare after chest surgery. Case presentation A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6 h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment. Conclusions Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.
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Affiliation(s)
- Lei Liu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China.,Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Wenbin Wu
- Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China
| | - Longbo Gong
- Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China
| | - Miao Zhang
- Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China.
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16
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Xiang X, Zhou H, Wu Y, Fang J, Lian Y. Impact of supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery. Medicine (Baltimore) 2020; 99:e19240. [PMID: 32150060 PMCID: PMC7478596 DOI: 10.1097/md.0000000000019240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration. METHODS The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T0), at the start of the surgical procedure (T1), 15 minutes later (T2), 30 minutes later (T3), and before the end of the surgical procedure (T4). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T5), 12 hours after surgery (T6), 24 hours after surgery (T7), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions. RESULTS There was no significant difference with the surgical visual field of the 3 groups (P > .05). The MAP, HR and SpO2 of the 3 groups were decreased from T2 to T3 compared with T0(P < .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier (P < .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher (P < .05). The static and dynamic NRS scores were lower from T5 to T7 (P < .05). Ramsay sedation scores were higher (P < .05), and the incidence of adverse reactions was lower (P < .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T6 to T7 (P < .05). CONCLUSION Supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery is safe and feasible.
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Affiliation(s)
- Xiaobing Xiang
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Huidan Zhou
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Yingli Wu
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Jun Fang
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Yanhong Lian
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
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17
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Hung WT, Cheng YJ, Chen JS. Nonintubated thoracoscopic surgery for early-stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:733-739. [PMID: 31605286 DOI: 10.1007/s11748-019-01220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Recent advances in the management of early-stage non-small cell lung cancer have focused on less invasive anesthetic and surgical techniques. Video-assisted thoracoscopic surgery without tracheal intubation is an evolving technique to provide a safe alternative with less short-term complication and faster postoperative recovery. The purpose of this review was to explore the latest developments and future prospects of nonintubated thoracoscopic surgery for early lung cancer. METHODS We examined various techniques and surgical procedures as well as the outcomes and benefits. RESULTS The results indicated a new era of video-assisted thoracoscopic surgery in which there is reduced procedure-related injury and enhanced postoperative recovery for lung cancer. CONCLUSIONS Nonintubated thoracoscopic surgery is a safe and feasible minimally invasive alternative surgery for early non-small cell lung cancer. Faster recovery and less short-term complication are potential benefits of this approach.
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Affiliation(s)
- Wan-Ting Hung
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan. .,National Taiwan University College of Medicine, Taipei, Taiwan.
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