1
|
van den Broek RJC, Postema JMC, Koopman JSHA, van Rossem CC, Olsthoorn JR, van Brakel TJ, Houterman S, Bouwman RA, Versyck B. Continuous erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracoscopic surgery: a prospective randomized open-label non-inferiority trial. Reg Anesth Pain Med 2024:rapm-2023-105047. [PMID: 38212049 DOI: 10.1136/rapm-2023-105047] [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: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery. METHODS We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization. RESULTS Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2. CONCLUSIONS The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL6433).
Collapse
Affiliation(s)
- Renee J C van den Broek
- Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Jonne M C Postema
- Department of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joseph S H A Koopman
- Department of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Barbara Versyck
- Department of Anaesthesiology and Pain Medicine, General Hospital Turnhout Campus Saint Elisabeth, Turnhout, Belgium
| |
Collapse
|
2
|
Zhou N, Niu J, Nelson D, Feldman HA, Antonoff MB, Hofstetter WL, Mehran RJ, Rice DC, Sepesi B, Swisher SG, Walsh GL, Giordano SH, Rajaram R. Surgical Approach and Persistent Opioid Use in Medicare Patients Undergoing Lung Cancer Resection. Ann Thorac Surg 2023; 116:1020-1027. [PMID: 36801207 DOI: 10.1016/j.athoracsur.2023.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/27/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Robotic and video-assisted thoracoscopic surgery (VATS) approaches for lung resection are associated with decreased inpatient opioid use compared with open surgery. Whether these approaches affect outpatient persistent opioid use remains unknown. METHODS Non-small cell lung cancer patients aged 66 years or more who underwent lung resection between 2008 and 2017 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Persistent opioid use was defined as filling an opioid prescription 3 to 6 months after lung resection. Adjusted analyses were performed to evaluate surgical approach and persistent opioid use. RESULTS We identified 19,673 patients: 7479 (38%) underwent open surgery, 10,388 (52.8%) VATS, and 1806 (9.2%) robotic surgery. Persistent opioid use was 38% in the entire cohort, including 27% of opioid naïve patients, and highest after open surgery (42.5%), followed by VATS (35.3%) and robotic (33.1%, P < .001). In multivariable analyses, robotic (odds ratio 0.84; 95% CI, 0.72-0.98; P = .028) and VATS (odds ratio 0.87; 95% CI, 0.79-0.95; P = .003) approaches were both associated with decreased persistent opioid use compared with open surgery in opioid naïve patients. At 12 months, patients resected using a robotic approach had the lowest oral morphine equivalent per month compared with VATS (133 vs 160, P < .001) and open surgery (133 vs 200, P < .001). Among chronic opioid patients, surgical approach was not associated with postoperative opioid use. CONCLUSIONS Persistent opioid use after lung resection is common. Both robotic and VATS approaches were associated with decreased persistent opioid use compared with open surgery among opioid naïve patients. Whether a robotic approach yields additional long-term advantages over VATS warrants further investigation.
Collapse
Affiliation(s)
- Nicolas Zhou
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jiangong Niu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Nelson
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hope A Feldman
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garret L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
3
|
Liu X, Meng D, Zhao Q, Yan C, Wang J. The efficacy and safety of acupuncture assisted anesthesia (AAA) for postoperative pain of thoracoscopy: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e28675. [PMID: 35089213 PMCID: PMC8797609 DOI: 10.1097/md.0000000000028675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery suggests the use of multimodal analgesia to optimize the perioperative pain management scheme. At present, studies have shown that the application of acupuncture combined anesthesia in thoracoscopy has achieved good curative effect. However, there is no relevant systematic evaluation. Our study is the first meta-analysis of the effectiveness and safety of acupuncture combined anesthesia in pain management after thoracoscopy, in order to provide strong evidence for clinical support. METHODS A comprehensive and systematic literature searching will mainly perform on 7 electronic databases (PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data, Chinese Biomedical Database) from their inception up to November 30, 2021. We will also search for ongoing or unpublished studies from other websites (eg, PROSPERO, ClinicalTrials.gov, Chinese Clinical Trial Registry) and do manual retrieval for potential gray literature. Only the relevant randomized controlled trials published in English or Chinese were included. Two independent investigators will independently complete literature selection, assessment of risk bias, and data extraction, the disagreements will be discussed with the third party for final decisions. The primary outcome measures: visual analog scale, intraoperative anesthetic dosage, and the consumption of postoperative analgesics. The secondary outcome measures: Pittsburgh Sleep Quality Index, the total sleep time after operation, residence time in the anesthesia recovery room, the duration of hospitalization, and the incidence of adverse reactions and serious events. Assessment of bias risk will follow the Cochrane risk of bias tool. Data processing will be conducted by Stata 15.0 software. RESULTS We will evaluate the efficacy and safety of acupuncture assisted anesthesia for postoperative pain after thoracoscopy based on randomized controlled trials. CONCLUSION This study can provide more comprehensive and strong evidence whether acupuncture assisted anesthesia is efficacy and safe for postoperative pain in thoracoscopy. REGISTRATION The research has been registered and approved on the INPLASY website. The registration number is INPLASY 2021120129.
Collapse
Affiliation(s)
- Xinyi Liu
- Institute of Literature and Culture of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Dan Meng
- Institute of Literature and Culture of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qinyu Zhao
- Institute of Innovation Research of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Chunchun Yan
- Institute of Acupuncture, Moxibustion, and Massage, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jingyu Wang
- Institute of Acupuncture, Moxibustion, and Massage, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| |
Collapse
|
4
|
Postoperative Pain in Thoracic Surgical Patients: An Analysis of Factors Associated With Acute and Chronic Pain. Heart Lung Circ 2021; 30:1244-1250. [DOI: 10.1016/j.hlc.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
|
5
|
Husch HH, Watte G, Zanon M, Pacini GS, Birriel D, Carvalho PL, Kessler A, Sbruzzi G. Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pulmonary Function, and Respiratory Muscle Strength After Posterolateral Thoracotomy: A Randomized Controlled Trial. Lung 2020; 198:345-353. [PMID: 32036406 DOI: 10.1007/s00408-020-00335-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/27/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU). METHODS Patients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outcomes were evaluated before surgery, immediately after, 24 and 48 h after ICU admission. RESULTS Forty-five patients were included. Regarding pain perception, there was no difference between groups (p = 0.172), but there was a significant reduction in pain intensity for patients receiving TENS after first physiotherapy session compared to baseline (4.7 ± 3.2 vs 3.3 ± 2.6; p < 0.05). All groups had a decrease in forced vital capacity (FVC) after surgery (p < 0.001). There was no difference between the groups regarding the use of analgesic medications, but a higher intake of morphine and acetaminophen were observed for the control (p = 0.037) and placebo group (p = 0.035), respectively. CONCLUSION The use of TENS provides a little benefit of pain (in the first 12 h) but failed to demonstrate any improvement in the recovery of ICU patients after 48 h of posterolateral thoracotomy. TRIAL REGISTRATION NCT02438241.
Collapse
Affiliation(s)
- Hermann H Husch
- Programa de Pós-Graduação Em Ciências Pneumológicas, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035002, Brazil
- Centro Universitário Ritter dos Reis - UniRitter, Rua Orfanotrófio 555, Porto Alegre, RS, 90840-440, Brazil
| | - Guilherme Watte
- Department of Clinical Research and Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, R. SarmentoLeite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Matheus Zanon
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, R. SarmentoLeite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Gabriel Sartori Pacini
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, R. SarmentoLeite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Daniella Birriel
- Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020-160, Brazil
| | - Pauline L Carvalho
- Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
| | - Adriana Kessler
- Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
| | - Graciele Sbruzzi
- Programa de Pós-Graduação Em Ciências Pneumológicas, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035002, Brazil.
- Universidade Federal Do Rio Grande Do Sul, Felizardo St 750, Porto Alegre, RS, 90690-200, Brazil.
| |
Collapse
|
6
|
Sztain JF, Gabriel RA, Said ET. Thoracic Epidurals are Associated With Decreased Opioid Consumption Compared to Surgical Infiltration of Liposomal Bupivacaine Following Video-Assisted Thoracoscopic Surgery for Lobectomy: A Retrospective Cohort Analysis. J Cardiothorac Vasc Anesth 2019; 33:694-698. [DOI: 10.1053/j.jvca.2018.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Indexed: 11/11/2022]
|
7
|
Kwon WK, Choi JW, Kang JE, Kang WS, Lim JA, Woo NS, Lee SA, Kim SH. Long Thoracic Nerve Block in Video-Assisted Thoracoscopic Wedge Resection for Pneumothorax. Anaesth Intensive Care 2019; 40:773-9. [DOI: 10.1177/0310057x1204000504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- W. K. Kwon
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology and Pain Medicine; and Research Institute of Medical Science, Konkuk University School of Medicine
| | - J. W. Choi
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - J. E. Kang
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - W. S. Kang
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - J. A. Lim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology and Pain Medicine; and Research Institute of Medical Science, Konkuk University School of Medicine
| | - N. S. Woo
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology and Pain Medicine; and Research Institute of Medical Science, Konkuk University School of Medicine
| | - S. A. Lee
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery; and Research Institute of Medical Science, Konkuk University School of Medicine
| | - S. H. Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology and Pain Medicine; and Research Institute of Medical Science, Konkuk University School of Medicine
| |
Collapse
|
8
|
Yu B, He M, Cai GY, Zou TX, Zhang N. Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly: A randomized controlled clinical trial (CONSORT). Medicine (Baltimore) 2016; 95:e5056. [PMID: 27759633 PMCID: PMC5079317 DOI: 10.1097/md.0000000000005056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Continuous femoral nerve block and fascia iliaca compartment block are 2 traditional anesthesia methods in orthopedic surgeries, but it is controversial which method is better. The objective of this study was to compare the practicality, efficacy, and complications of the 2 modalities in hip replacement surgery in the elderly and to assess the utility of a novel cannula-over-needle set. METHODS In this prospective, randomized controlled clinical investigation, 60 elderly patients undergoing hip replacement were randomly assigned to receive either continuous femoral nerve block or continuous fascia iliaca compartment block. After ultrasound-guided nerve block, all patients received general anesthesia for surgery and postoperative analgesia through an indwelling cannula. Single-factor analysis of variance was used to compare the outcome variables between the 2 groups. RESULTS There was a significant difference between the 2 groups in the mean visual analog scale scores (at rest) at 6 hours after surgery: 1.0 ± 1.3 in the femoral nerve block group vs 0.5 ± 0.8 in the fascia iliaca compartment block group (P < 0.05). The femoral nerve block group had better postoperative analgesia on the medial aspect of the thigh, whereas the fascia iliaca compartment block group had better analgesia on the lateral aspect of the thigh. There were no other significant differences between the groups. CONCLUSIONS Both ultrasound-guided continuous femoral nerve block and fascia iliaca compartment block with the novel cannula-over-needle provide effective anesthesia and postoperative analgesia for elderly hip replacement patients.
Collapse
Affiliation(s)
- Bin Yu
- Department of Anesthesiology, Tongji Hospital of Tongji University, Shanghai, China
- Correspondence: Bin Yu, Department of Anesthesiology, Tongji Hospital of Tongji University, Shanghai, China. (e-mail: )
| | | | | | | | | |
Collapse
|
9
|
Kar P, Gopinath R, Durga P, Kumar RV. Anaesthetic management in a case of concurrent hypertrophic cardiomyopathy and constrictive pericarditis: Are there special concerns? Indian J Anaesth 2016; 60:206-8. [PMID: 27053786 PMCID: PMC4800939 DOI: 10.4103/0019-5049.177868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Prachi Kar
- Department of Anaesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ramachandran Gopinath
- Department of Anaesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Padmaja Durga
- Department of Anaesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - R V Kumar
- Department of Cardiothoracic Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
10
|
Fibla JJ, Molins L, Mier JM, Hernandez J, Sierra A. A randomized prospective study of analgesic quality after thoracotomy: paravertebral block with bolus versus continuous infusion with an elastomeric pump†. Eur J Cardiothorac Surg 2014; 47:631-5. [DOI: 10.1093/ejcts/ezu246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique. Braz J Anesthesiol 2013; 63:213-9. [PMID: 24565129 DOI: 10.1016/j.bjane.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/22/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. METHODS Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphine-ropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30(th) and 60(th) minutes and the 2(nd), 4(th), 6(th), 12(th), 24(th), 36(th), 48(th), and 72(nd) hour. RESULTS Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48(th) hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30(th) and 60(th) minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30(th) minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. CONCLUSIONS Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.
Collapse
|
12
|
Comparison of Intravenous Morphine, Epidural Morphine With/ Without Bupivacaine or Ropivacaine in Postthoracotomy Pain Management With Patient Controlled Analgesia Technique. Braz J Anesthesiol 2013; 63:213-9. [DOI: 10.1016/s0034-7094(13)70218-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022] Open
|
13
|
Subpleural block is less effective than thoracic epidural analgesia for post-thoracotomy pain. Eur J Anaesthesiol 2012; 29:186-91. [DOI: 10.1097/eja.0b013e32834fcef7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Mansouri M, Bageri K, Noormohammadi E, Mirmohammadsadegi M, Mirdehgan A, Ahangaran AG. Randomized controlled trial of bilateral intrapleural block in cardiac surgery. Asian Cardiovasc Thorac Ann 2011; 19:133-8. [PMID: 21471258 DOI: 10.1177/0218492311400921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the efficacy of bilateral intrapleural block with bupivacaine as a preemptive analgesic for postoperative pain in coronary artery bypass graft surgery. In a double-blind prospective clinical trial, 70 patients were randomly divided into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline 1/200,000 each side) and a control group (20.5 mL normal saline each side). Evaluation of the severity of pain was performed using the visual analog scale at 12 and 24 h after entering the intensive care unit and again during chest tube removal. Pain scores at 12 and 24 h after intensive care unit admission were significantly lower in the bupivacaine group. There were no side-effects related to intrapleural block, such as pneumothorax or emphysema. In coronary artery bypass graft candidates, preemptive analgesia with bilateral intrapleural block using bupivacaine provided relatively less painful conditions during the first 24 h after surgery, but it did not improve the clinical outcome.
Collapse
Affiliation(s)
- Mojtaba Mansouri
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | | | | | | | | |
Collapse
|
15
|
Mustola ST, Lempinen J, Saimanen E, Vilkko P. Efficacy of Thoracic Epidural Analgesia With or Without Intercostal Nerve Cryoanalgesia for Postthoracotomy Pain. Ann Thorac Surg 2011; 91:869-73. [DOI: 10.1016/j.athoracsur.2010.11.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/09/2010] [Accepted: 11/10/2010] [Indexed: 11/17/2022]
|
16
|
Is Epidural Analgesia Necessary after Video-Assisted Thoracoscopic Lobectomy? Asian Cardiovasc Thorac Ann 2010; 18:464-8. [DOI: 10.1177/0218492310381817] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most studies have shown that thoracic epidural analgesia reduces postoperative pain, but it carries potential risks. Recently, video-assisted thoracoscopic surgery has become an established technique that causes minimal postoperative pain. This report shows that thoracic epidural analgesia is not always necessary after video-assisted thoracoscopic lobectomy. From January to December 2007, 30 consecutive patients who underwent video-assisted thoracoscopic lobectomy were examined retrospectively. We analyzed the necessity for routine thoracic epidural analgesia. The continuous subcutaneous analgesia catheter for morphine (2 mg in 48 h) was removed from 15 patients on postoperative day 1, and from the other 15 on day 2. We administered loxoprofen sodium hydrate, diclofenac sodium suppository, pentazocine hydrochloride, and mexiletine hydrochloride for postoperative analgesia, as needed. The mean pain score was no more than 1.0. The maximum score was 3.0 on day 0, and 2.0 on day 14; subsequently, no pain score exceeded 2.0. The postoperative hospital stay was 8.7 ± 0.8 days. All patients made uneventful postoperative recoveries. There is no need for thoracic epidural analgesia after every video-assisted thoracoscopic lobectomy because our patients recovered with no serious complication. Less invasive surgical approaches should require simpler postoperative pain management.
Collapse
|
17
|
|
18
|
Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, Neugebauer EAM, Rawal N, Schug SA, Simanski C, Kehlet H. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107:1026-40. [PMID: 18713924 DOI: 10.1213/01.ane.0000333274.63501.ff] [Citation(s) in RCA: 393] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation of the evidence is needed to assess the comparative benefits of alternative techniques, guide clinical practice and identify areas requiring further research. METHODS In this systematic review of randomized trials we evaluated thoracic epidural, paravertebral, intrathecal, intercostal, and interpleural analgesic techniques, compared to each other and to systemic opioid analgesia, in adult thoracotomy. Postoperative pain, analgesic use, and complications were analyzed. RESULTS Continuous paravertebral block was as effective as thoracic epidural analgesia with local anesthetic (LA) but was associated with a reduced incidence of hypotension. Paravertebral block reduced the incidence of pulmonary complications compared with systemic analgesia, whereas thoracic epidural analgesia did not. Thoracic epidural analgesia was superior to intrathecal and intercostal techniques, although these were superior to systemic analgesia; interpleural analgesia was inadequate. CONCLUSIONS Either thoracic epidural analgesia with LA plus opioid or continuous paravertebral block with LA can be recommended. Where these techniques are not possible, or are contraindicated, intrathecal opioid or intercostal nerve block are recommended despite insufficient duration of analgesia, which requires the use of supplementary systemic analgesia. Quantitative meta-analyses were limited by heterogeneity in study design, and subject numbers were small. Further well designed studies are required to investigate the optimum components of the epidural solution and to rigorously evaluate the risks/benefits of continuous infusion paravertebral and intercostal techniques compared with thoracic epidural analgesia.
Collapse
Affiliation(s)
- Girish P Joshi
- Department of Anesthesiology and Pain Management, University of TX Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Yildirim V, Akay HT, Bingol H, Bolcal C, Oz K, Kaya E, Demirkilic U, Tatar H. Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function. J Clin Anesth 2007; 19:506-11. [DOI: 10.1016/j.jclinane.2007.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 03/28/2007] [Accepted: 04/11/2007] [Indexed: 11/29/2022]
|
20
|
Post-thoracotomy Pain. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
21
|
Yoo SH, Seo HJ, Kim CS, Ahn KR, Kang KS, Jung JH, Chun KA, Kim JB. Anatomical Investigations for Appropriate Needle Positioning in Thoracic Paravertebral Blockade. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sie Hyeon Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Hwan Joo Seo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Chun Sook Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Ki Ryang Ahn
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Kyu Sik Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Jin Hun Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Kyung Ah Chun
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong Bun Kim
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Sarimehmetoglu F, Çöçelli LP, Serin G, Sarimehmetoglu A, Öner Ü. 760 THE EFFICENCY OF PREEMPTIVE ANALGESIA SECURED BY THORACAL EPIDURAL ANESTHESIA ON RESPIRATUAR FUNCTIONS AND PAIN MANAGEMENT. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
23
|
Akin S, Aribogan A, Turunc T, Aridogan A. Lumbar plexus blockade with ropivacaine for postoperative pain management in elderly patients undergoing urologic surgeries. Urol Int 2006; 75:345-9. [PMID: 16327304 DOI: 10.1159/000089172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Accepted: 07/13/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We evaluated the effectiveness and safety of lumbar plexus blockade with ropivacaine for postoperative pain relief in elderly patients undergoing flank incision for urological surgery. METHODS 60 urological patients (>65 years old) were chosen randomly for paravertebral lumbar blockade. Postoperatively ropivacaine was used in group I (n = 30) and bupivacaine was administered in group II (n = 30) for lumbar plexus blockade. Heart rates, systolic and diastolic blood pressures, peripheral oxygen saturations, analgesia levels with visual analogue scales (VAS) were measured postoperatively at 5 and 30 min and 1, 3, 6, 8,and 12 h. Patient satisfaction scores and complications were recorded. RESULTS The hemodynamic parameters of the groups were in the normal ranges (p > 0.05). VAS were significantly decreased at 60 min in both groups (p < 0.05) and no important increase was observed during the first 8 h (p > 0.05). After the 8-hour measurement, analgesic was given to 7 patients in group I and 6 patients in group II (p < 0.05). There were no complications (p > 0.05). Patient satisfaction scores were found to be higher for all patients (p > 0.05). CONCLUSION In elderly patients, lumbar plexus blockade with ropivacaine can be a simple, safe and effective analgesic technique especially in the early postoperative period after urologic surgeries with flank incision.
Collapse
Affiliation(s)
- Sule Akin
- Department of Anesthesiology and Intensive Care, University of Baskent, Adana, Turkey
| | | | | | | |
Collapse
|
24
|
Abstract
Intrathecal opioids are widely used as useful adjuncts in the treatment of acute and chronic pain, and a number of non-opioid drugs show promise as analgesic drugs with spinal selectivity. In this review we examine the historical development and current use of intrathecal opioids and other drugs that show promise for treating pain in the perioperative period. The pharmacology and clinical use of intrathecal morphine and other opioids is reviewed in detail, including dosing guidelines for specific surgical procedures and the incidence and treatment of side effects associated with these drugs. Available data on the use of non-opioid drugs that have been tested intrathecally for use as analgesics are also reviewed. Evidence-based guidelines for dosing of intrathecal drugs for specific surgical procedures and for the treatment of the most common side effects associated with these drugs are presented.
Collapse
Affiliation(s)
- James P Rathmell
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
| | | | | |
Collapse
|
25
|
Ochroch EA, Gottschalk A, Augoustides JG, Aukburg SJ, Kaiser LR, Shrager JB. Pain and Physical Function Are Similar Following Axillary, Muscle-Sparing vs Posterolateral Thoracotomy. Chest 2005; 128:2664-70. [PMID: 16236940 DOI: 10.1378/chest.128.4.2664] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY OBJECTIVES We set out to determine whether there is a difference in postoperative pain and recovery after the patient undergoes the axillary muscle-sparing incision (ie, muscle-sparing thoracotomy [MT]) vs the modified posterolateral incision (ie, posterolateral thoracotomy [PT]). DESIGN Analysis of a database originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy. SETTING The Hospital of the University of Pennsylvania. PATIENTS Patients presenting for lobectomy, segmentectomy, or bilobectomy. MEASUREMENTS Pain, physical activity, and the extent that pain interfered with activities following major thoracotomy were prospectively assessed with standard questionnaires (ie, the brief pain inventory and the Medical Outcomes Study 36-item short form) on postoperative days 1 to 5, and at postoperative weeks 4, 8, 12, 24, 36, and 48 by a blinded research assistant. Perioperative care was standardized and included patient-controlled thoracic epidural analgesia until thoracostomy tube removal. RESULTS Eighty-two subjects underwent MT and 38 subjects underwent PT during the 16-month accrual period. There were no significant differences in demographics. Pain reported during hospitalization and after hospital discharge did not differ with respect to incision type (p > or = 0.17). Postoperative physical activity levels were significantly less than those reported preoperatively, with a trend toward better functioning in the MT groups after 8 weeks. Incision type did not predict complications, morbidity, or mortality. CONCLUSIONS When comparing patients who had undergone vertical, axillary, wholly MT to those who had undergone modified serratus muscle-sparing PT, postoperative differences in pain were not apparent. One should not anticipate reduced pain or more rapid overall recovery following MT, at least when epidural analgesia is used aggressively for perioperative pain control.
Collapse
Affiliation(s)
- E Andrew Ochroch
- Department of Anesthesiology, University of Pennsylvania Health System, 3400 Spruce St, 680 Dulles, Philadelphia, PA 19104, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Turker G, Goren S, Bayram S, Sahin S, Korfali G. Comparison of Lumbar Epidural Tramadol and Lumbar Epidural Morphine for Pain Relief After Thoracotomy: A Repeated-Dose Study. J Cardiothorac Vasc Anesth 2005; 19:468-74. [PMID: 16085251 DOI: 10.1053/j.jvca.2005.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to compare lumbar epidural morphine and lumbar epidural tramadol with respect to onset and duration of analgesia, analgesic efficacy, and drug-related side effects after muscle-sparing thoracotomy. DESIGN Prospective, randomized, double-blind, clinical study. SETTING Single university hospital. PARTICIPANTS Forty patients who underwent elective muscle-sparing thoracotomy. INTERVENTIONS Before anesthesia induction, an epidural catheter was placed in the L2-3 or L3-4 interspace using the loss-of-resistance technique. On arrival at the intensive care unit, patients were randomized to receive doses of either 100 mg of tramadol (group T) or 4 mg of morphine (group M) via the lumbar epidural catheter. Each dose was diluted in 10 mL of normal saline. On awakening from anesthesia, if the patient's pain score on a 0- to 100-mm visual analog scale was above 40 mm, the initial epidural drug dose was administered. The initial injection in each case was taken as time 0. Subsequent pain scores above 40 mm were considered indications for epidural dosing; each patient was allowed 2 doses in the first 12 hours postoperatively and 2 more in the second 12 hours. MEASUREMENTS AND MAIN RESULTS The groups' analgesia onset times were similar, but duration of analgesia was significantly shorter in group T than in group M (p < 0.01). There were no differences between the groups with respect to pain scores at rest or during coughing at any of the time points investigated. Sedation scores were lower in group T than in group M at 1, 2, 3, 4, and 8 hours (p value range, 0.0001-0.05). Compared with group T, group M showed significantly greater drops in arterial oxygen tension from baseline at 3, 4, 8, and 12 hours (p value range, 0.0001-0.05). The group means for arterial carbon dioxide tension and respiratory rate were similar at all time points investigated. CONCLUSION The study revealed that the quality of analgesia achieved with repeated doses of lumbar epidural tramadol after muscle-sparing thoracotomy is comparable to that achieved with repeated doses of lumbar epidural morphine. Compared with morphine, lumbar epidural tramadol results in less sedation and a less-pronounced decrease in oxygenation.
Collapse
Affiliation(s)
- Gurkan Turker
- Department of Anesthesiology and Reanimation, Uludag University Medical School, 16059 Görükle/Bursa, Turkey.
| | | | | | | | | |
Collapse
|
27
|
Karakaya D, Baris S, Ozkan F, Demircan S, Gök U, Ustün E, Tür A. Analgesic effects of interpleural bupivacaine with fentanyl for post-thoracotomy pain. J Cardiothorac Vasc Anesth 2005; 18:461-5. [PMID: 15365929 DOI: 10.1053/j.jvca.2004.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The analgesic effect of bupivacaine/fentanyl with epinephrine given interpleurally after thoracotomy was investigated in a randomized placebo and intravenous controlled study. DESIGN Prospective clinical study. SETTING University teaching hospital. PARTICIPANTS Sixty American Society of Anesthesiologists physical status II and III patients scheduled for posterolateral thoracotomy with general anesthesia. INTERVENTIONS Patients were randomly divided into 4 groups to receive either 0.5% bupivacaine/1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine (n = 15, group IPBF), 0.5 % bupivacaine with 5 microg/mL of epinephrine (n = 15, group IPB), or saline (n = 15, group IPS) in a total volume of 15 to 20 mL in 60 seconds by an interpleural catheter placed at the end of surgery by direct vision. The same volume of bupivacaine 0.25% and 1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine to group IPBF, bupivacaine 0.25% with 5 microg/mL of epinephrine to group IPB or saline to group IPS was injected through the interpleural catheter every 6 hours for 48 hours postoperatively. Intravenous fentanyl (n = 15, group IVF) and interpleural saline groups received 1.5 microg/kg of fentanyl intravenously at the first complaint of pain. All patients also received patient-controlled analgesia (PCA) with fentanyl for 48 hours postoperatively. Metamizol sodium was used as a rescue analgesic. MEASUREMENTS AND MAIN RESULTS Adequacy of pain relief was evaluated with the "Prince Henry Pain Scale" and visual analog pain scale. Fentanyl consumption via PCA and complications were evaluated for 48 hours. Visual analog scale scores were significantly higher in the interpleural saline group at 4 and 12 hours (6.6 +/- 1.2 and 5.0 +/- 2.1, respectively) postoperatively. Significantly more patients in the IPBF group had lower pain scores during coughing and deep breathing. Fentanyl consumption via PCA device was significantly higher in the intravenous fentanyl group (1,069 +/- 96.9 microg) than the interpleural groups (577.3 +/- 72.2 microg, 651.1 +/- 61.9 microg, and 601.0 +/- 22.6 microg in IPBF, IPB, and IPS groups, respectively). CONCLUSION It is concluded that total fentanyl consumption via PCA decreased in all interpleural groups, but pain during coughing and deep breathing was significantly reduced in only the interpleural bupivacaine/fentanyl with epinephrine group.
Collapse
Affiliation(s)
- Deniz Karakaya
- Ondokuz Mayis University, Tip Fakültesi, Anesteziyoloji ve Reanimasyon, Anabilim Dali, 55139, Kurupelit, Samsun, Turkey.
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Perioperative analgesia for thoracotomy has evolved in concert with increasing knowledge of the impact of pain on recovery, the origin of this pain, and new methods for treating it. Thoracic surgery is one of the few areas where there is more general agreement between surgeons and anesthesiologists as to the importance of aggressive pain management, often with an indwelling epidural catheter left in place until after thoracostomy tube removal. The reasons for this agreement is that it has become increasingly clear to both specialties that pain puts patients with decreased pulmonary reserve who undergo thoracotomy at greater risk for morbidity. Future studies need to examine drugs or drug combinations that can lead to further reductions in the often intense pain that patients receiving aggressive epidural analgesia still experience. Studies directed at finding interventions capable of reducing the rate of long-term postthoracotomy pain still need to be performed.
Collapse
Affiliation(s)
- E Andrew Ochroch
- Department of Anesthesia, University of Pennsylvania Health System, 3400 Spruce Street, 680 Dulles Building, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
29
|
Abstract
Thoracic procedures are considered to be among the most painful surgical incisions and are associated with considerable postoperative pain and shoulder dysfunction, severely affecting mobility and activities of daily living. Improper patient positioning, muscle division, perioperative nerve injury, rib spreading, and consequent postoperative pain influence the patient's postoperative shoulder function and quality of life. To reduce access trauma and postoperative morbidity, various alternative modalities have been proposed to replace the standard PLT, including muscle-sparing techniques and VATS. Initial evaluations suggest that these alternatives are associated with significantly better postoperative shoulder function. Proper comparative studies using standardized questionnaires, objective evaluations, or quality-of-life assessments are scarce, however. Proper postoperative care, including early mobilization and effective physiotherapy, is a cornerstone in successful patient rehabilitation and rapid return to normal daily activities. Whether upper extremity exercises can contribute to improvement in postoperative shoulder function and the ability to perform activities of daily living needs to be studied further.
Collapse
Affiliation(s)
- Wilson W L Li
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China
| | | | | |
Collapse
|
30
|
Fotiadis RJ, Badvie S, Weston MD, Allen-Mersh TG. Epidural analgesia in gastrointestinal surgery. Br J Surg 2004; 91:828-41. [PMID: 15227688 DOI: 10.1002/bjs.4607] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The ideal perioperative analgesia should provide effective pain relief, avoid the detrimental effects of the stress response, be simple to administer without the need for intensive monitoring, and have a low risk of complications. METHODS This review defines the physiological effects of epidural analgesia and assesses whether the available evidence supports its preferential use in gastrointestinal surgery. All papers studied were identified from a Medline search or selected by cross-referencing. RESULTS Epidural analgesia is associated with a shorter duration of postoperative ileus, attenuation of the stress response, fewer pulmonary complications, and improved postoperative pain control and recovery. It does not reduce anastomotic leakage, intraoperative blood loss, transfusion requirement, risk of thromboembolism or cardiac morbidity, or hospital stay compared with that after conventional analgesia in unselected patients undergoing gastrointestinal surgery. Thoracic epidural analgesia reduces hospital costs and stay in patients at high risk of cardiac or pulmonary complications. CONCLUSIONS Epidural analgesia enhances recovery after gastrointestinal surgery. The results support the development of structured regimens of early postoperative feeding and mobilization to exploit the potential for thoracic epidural analgesia to reduce hospital stay after gastrointestinal surgery.
Collapse
Affiliation(s)
- R J Fotiadis
- Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Imperial College London, London, UK
| | | | | | | |
Collapse
|
31
|
Yun YO, Oh SC, Park JM, Yoon KJ. Continuous Thoracic Paravertebral Block for Pain Management Following Thoracotomy. Korean J Pain 2004. [DOI: 10.3344/jkps.2004.17.2.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yeo Ok Yun
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Sae Cheol Oh
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Jong Min Park
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Keon Jung Yoon
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| |
Collapse
|