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Tokuishi K, Wakahara JI, Ueda Y, Miyahara S, Nakashima H, Masuda Y, Waseda R, Shiraishi T, Sato T. Factors related to post-thoracotomy pain following robotic-assisted thoracic surgery. Asian J Endosc Surg 2024; 17:e13302. [PMID: 38523354 DOI: 10.1111/ases.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Robotic-assisted thoracic surgery (RATS) is a minimally invasive procedure; however, some patients experience persistent postoperative pain. This study aimed to investigate factors related to postoperative pain following RATS. METHODS The data of 145 patients with lung cancer, who underwent RATS with a four-port (one in the sixth intercostal space [ICS] and three in the eighth ICS) lobectomy or segmentectomy between May 2019 and December 2022, were retrospectively analyzed. Factors associated with analgesic use for at least 2 months following postoperative pain (PTP group) were analyzed. RESULTS Patients who underwent preoperative pain control for any condition or chest wall resection were excluded. Among the 138 patients, 45 (32.6%) received analgesics for at least 2 months after surgery. Patient height and transverse length of the thorax correlated with PTP in the univariate analysis (non-PTP vs. PTP; height, 166 vs. 160 cm; p < .001; transverse length of the thorax, 270 vs. 260 mm, p = .016). In the multivariate analysis, height was correlated with PTP (p = .009; odds ratio, 0.907; 95% confidence interval, 0.843-0.976). Height correlated with the transverse length of the thorax (r = .407), anteroposterior length of the thorax (r = .294), and width of the eighth ICS in the middle axillary line (r = .210) using Pearson's correlation coefficients. When utilizing a 165-cm cutoff value for height to predict PTP using receiver operating characteristic curve analysis, the area under the curve was 0.69 (95% confidence interval, 0.601-0.779). CONCLUSION Short stature is associated with a high risk of postoperative pain following RATS.
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Affiliation(s)
- Keita Tokuishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Jun-Ichi Wakahara
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuichiro Ueda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - So Miyahara
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroyasu Nakashima
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshiko Masuda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ryuichi Waseda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Toshihiko Sato
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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Chenesseau J, Fourdrain A, Pastene B, Charvet A, Rivory A, Baumstarck K, Bouabdallah I, Trousse D, Boulate D, Brioude G, Gust L, Vasse M, Braggio C, Mora P, Labarriere A, Zieleskiewicz L, Leone M, Thomas PA, D’Journo XB. Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery: A Randomized Clinical Trial. JAMA Surg 2023; 158:1255-1263. [PMID: 37878299 PMCID: PMC10600725 DOI: 10.1001/jamasurg.2023.5228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/01/2023] [Indexed: 10/26/2023]
Abstract
Importance In minimally invasive thoracic surgery, paravertebral block (PVB) using ultrasound (US)-guided technique is an efficient postoperative analgesia. However, it is an operator-dependent process depending on experience and local resources. Because pain-control failure is highly detrimental, surgeons may consider other locoregional analgesic options. Objective To demonstrate the noninferiority of PVB performed by surgeons under video-assisted thoracoscopic surgery (VATS), hereafter referred to as PVB-VATS, as the experimental group compared with PVB performed by anesthesiologists using US-guided technique (PVB-US) as the control group. Design, Setting, and Participants In this single-center, noninferiority, patient-blinded, randomized clinical trial conducted from September 8, 2020, to December 8, 2021, patients older than 18 years who were undergoing a scheduled minimally invasive thoracic surgery with lung resection including video-assisted or robotic approaches were included. Exclusion criteria included scheduled open surgery, any antalgic World Health Organization level greater than 2 before surgery, or a medical history of homolateral thoracic surgery. Patients were randomly assigned (1:1) to an intervention group after general anesthesia. They received single-injection PVB before the first incision was made in the control group (PVB-US) or after 1 incision was made under thoracoscopic vision in the experimental group (PVB-VATS). Interventions PVB-VATS or PVB-US. Main Outcomes and Measures The primary end point was mean 48-hour post-PVB opioid consumption considering a noninferiority range of less than 7.5 mg of opioid consumption between groups. Secondary outcomes included time of anesthesia, surgery, and operating room occupancy; 48-hour pain visual analog scale score at rest and while coughing; and 30-day postoperative complications. Results A total of 196 patients were randomly assigned to intervention groups: 98 in the PVB-VATS group (mean [SD] age, 64.6 [9.5] years; 53 female [54.1%]) and 98 in the PVB-US group (mean [SD] age, 65.8 [11.5] years; 62 male [63.3%]). The mean (SD) of 48-hour opioid consumption in the PVB-VATS group (33.9 [19.8] mg; 95% CI, 30.0-37.9 mg) was noninferior to that measured in the PVB-US group (28.5 [18.2] mg; 95% CI, 24.8-32.2 mg; difference: -5.4 mg; 95% CI, -∞ to -0.93; noninferiority Welsh test, P ≤ .001). Pain score at rest and while coughing after surgery, overall time, and postoperative complications did not differ between groups. Conclusions and Relevance PVB placed by a surgeon during thoracoscopy was noninferior to PVB placed by an anesthesiologist using ultrasonography before incision in terms of opioid consumption during the first 48 hours. Trial Registration ClinicalTrials.gov Identifier: NCT04579276.
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Affiliation(s)
- Josephine Chenesseau
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Bruno Pastene
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Aude Charvet
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Adrien Rivory
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Karine Baumstarck
- Departement of Biostatistics, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Ilies Bouabdallah
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Delphine Trousse
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - David Boulate
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Lucile Gust
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Matthieu Vasse
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Cesare Braggio
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre Mora
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Ambroise Labarriere
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Medicine, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier-Benoit D’Journo
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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3
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Tam JKC. Opioid prescription guideline is important to enhanced recovery after thoracic surgery protocol. J Thorac Dis 2023; 15:5275-5277. [PMID: 37969260 PMCID: PMC10636438 DOI: 10.21037/jtd-23-1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/25/2023] [Indexed: 11/17/2023]
Affiliation(s)
- John Kit Chung Tam
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
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Stamenovic D, Schiller P, Karampinis I, Galata C, Roessner ED. Uniportal robotic assisted surgery for anatomical lung resection-First German experience. Int J Med Robot 2023:e2580. [PMID: 37792964 DOI: 10.1002/rcs.2580] [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: 06/25/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Uniportal robotic-assisted thoracic surgery (uRATS) has emerged as a promising technique with potential advantages over multiportal approaches. This study aims to evaluate our initial outcomes of uRATS. MATERIAL AND METHODS Five patients underwent anatomic lung resections with systematic nodal dissection through a uniportal robotic approach by one surgeon. The results were compared to the results of the first five uniportal video-assisted thoracic surgery (uVATS) anatomical resections performed by the same surgeon. RESULTS No adverse events occurred during the uRATS-procedures. Comparable surgical outcomes were observed between uRATS and uVATS, including hospital stays, complication rates, and blood loss. The average procedural time was slightly but non-significantly longer in the uRATS-group. Average pain-scores were lower in the uRATS group. One patient in each group experienced major postoperative complications, with one case of in-hospital mortality in the uRATS-group. CONCLUSION The outcomes of uRATS/uVATS were comparable, highlighting the potential and the feasibility of this technique. Prospective studies comparing the learning curves, complication rate and hospital-stay are required in order to justify the superiority of robotics over uVATS.
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Affiliation(s)
- Davor Stamenovic
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - P Schiller
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - I Karampinis
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - C Galata
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
| | - E D Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Mainz, Germany
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5
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Díaz-Bohada L, Segura-Salguero JC, Aristizabal-Mayor JD, Miranda-Pineda N, Perea-Bello AH, Wąsowicz M. Erector spinae plane block, neuropathic pain and quality of life after video-assisted thoracoscopy surgery. Pilot, observational study. Anaesthesiol Intensive Ther 2023; 55:87-92. [PMID: 37409833 PMCID: PMC10415606 DOI: 10.5114/ait.2023.128643] [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: 11/03/2022] [Accepted: 02/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high while the quality of life (QoL) after VATS remains unknown. We hypothesised that patients with ESPB would have a low incidence of acute and CNP and would report a good QoL up to three months after VATS. METHODS We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. RESULTS We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. CONCLUSIONS We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively.
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Affiliation(s)
- Lorena Díaz-Bohada
- Department of Anesthesiology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Nelcy Miranda-Pineda
- Education Faculty, Fundación Universitaria Navarra – Uninavarra, Neiva, Colombia
| | - Ana H. Perea-Bello
- Department of Anesthesiology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Marcin Wąsowicz
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
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Zou Y, Jin Z, Li MY, Tang L, Chen K. Experimental Study on the Central Mechanism of Penehyclidine Hydrochloride against Relapse Behavior in Morphine-Dependent Rats. Appl Bionics Biomech 2022; 2022:7785714. [PMID: 35126663 PMCID: PMC8813258 DOI: 10.1155/2022/7785714] [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: 10/13/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This article is mainly to study the central mechanism of penehyclidine hydrochloride against relapse behavior in morphine-dependent rats. METHODS The rats were randomly divided into the blank control group (k), PHC low-dose group (LP according to a body weight of 0.22 mg/kg), middle-dose group (MP according to a body weight of 0.55 mg/kg), high-dose group (HP according to a body weight of 1.38 mg/kg), and administration group, with 40 rats in each group. Each group was randomly divided into 5 subgroups (n = 10): 4 h after administration, 7 h after administration, 13 h after administration, 25 h after administration (K48, LP48, MP48, and HP48), and 37 h after administration, and then, Morris water maze experiment and immunohistochemical detection of the rat brain hippocampus were carried out. RESULTS 4 and 7 hours after administration, compared with group 1, the TchE activity increased and Ach level decreased in groups 2, 3, and 4 and the difference was significant (P < 0.05), so the principle of penehyclidine hydrochloride against morphine-dependent rats is that penehyclidine hydrochloride causes cognitive impairment in the brain of mice, thereby achieving antimorphine effects.
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Affiliation(s)
- Yufeng Zou
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei, China
| | - Zhe Jin
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei, China
| | - Meng Yun Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei, China
| | - Lijuan Tang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei, China
| | - Kai Chen
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei, China
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Postoperative opioid use after lobectomy for primary lung cancer: A propensity-matched analysis of Premier hospital data. J Thorac Cardiovasc Surg 2021; 162:259-268.e4. [DOI: 10.1016/j.jtcvs.2020.04.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 01/21/2023]
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8
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Pedoto A, Noel J, Park BJ, Amar D. Liposomal Bupivacaine Versus Bupivacaine Hydrochloride for Intercostal Nerve Blockade in Minimally Invasive Thoracic Surgery. J Cardiothorac Vasc Anesth 2020; 35:1393-1398. [PMID: 33376072 DOI: 10.1053/j.jvca.2020.11.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The objective of this study was to compare the effects of liposomal bupivacaine (Lipo-B) and bupivacaine hydrochloride (B-HCl), in the presence of multimodal analgesia, on postoperative analgesia and opioid consumption in minimally invasive thoracic surgery (MITS) lobectomy. DESIGN Retrospective observational cohort study. SETTING Tertiary care cancer center. PARTICIPANTS A total of 60 patients who underwent MITS lobectomy and received intercostal nerve blockade (ICNB) with either 0.66% Lipo-B (n = 29) or 0.5% B-HCl (n = 31). INTERVENTIONS All patients received intravenous patient-controlled analgesia for the first 12 hours postoperatively, followed by opioids and nonsteroidal anti-inflammatory drugs as needed. MEASUREMENTS AND MAIN RESULTS Perioperative opioid and nonopioid consumption and pain scores were compared between groups at 12-hour intervals for the first 72 hours. Between the two groups, there were no statistically significant differences in demographic characteristics, intraoperative (p = 0.46) and postoperative opioid consumption, Richmond Agitation-Sedation Scale scores and pain scores upon postanesthesia care unit arrival and after four hours, length of postanesthesia care unit stay (p = 0.84), or length of hospital stay (p = 0.55). Both groups received intra- and postoperative multimodal analgesia. CONCLUSIONS In this cohort, no differences in opioid consumption or pain scores were observed in the immediate postoperative period following MITS lobectomy between patients given ICNB with Lipo-B and those given ICNB with B-HCl in the presence of multimodal analgesia.
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Affiliation(s)
- Alessia Pedoto
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Jovanka Noel
- Hunter College, City University of New York, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Amar
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
This paper is the forty-first consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2018 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (2), the roles of these opioid peptides and receptors in pain and analgesia in animals (3) and humans (4), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (5), opioid peptide and receptor involvement in tolerance and dependence (6), stress and social status (7), learning and memory (8), eating and drinking (9), drug abuse and alcohol (10), sexual activity and hormones, pregnancy, development and endocrinology (11), mental illness and mood (12), seizures and neurologic disorders (13), electrical-related activity and neurophysiology (14), general activity and locomotion (15), gastrointestinal, renal and hepatic functions (16), cardiovascular responses (17), respiration and thermoregulation (18), and immunological responses (19).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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10
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Allain PA, Carella M, Agrafiotis AC, Burey J, Assouad J, Hafiani EM, Ynineb Y, Bonnet F, Garnier M, Quesnel C. Comparison of several methods for pain management after video-assisted thoracic surgery for pneumothorax: an observational study. BMC Anesthesiol 2019; 19:120. [PMID: 31279330 PMCID: PMC6612410 DOI: 10.1186/s12871-019-0797-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/27/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been proposed but remain poorly evaluated in this context. We aimed to assess the analgesic efficacy of several of these techniques for the management of postoperative pain. METHODS We conducted a monocentric prospective observational cohort study from February 2017 to April 2018 in patients suffering from spontaneous pneumothorax and scheduled for VATS (n = 59). Patients received systemic analgesia (i) alone (n = 15); (ii) combined with a continuous paravertebral block (n = 9); (iii) combined with a continuous serratus plane block (n = 19); or (iv) single-shot serratus plane block (n = 16) as decided by the attending physician. Pain scores and analgesic-related side effects were prospectively collected by an independent observer during the first postoperative 72 h. The primary endpoint criterion was the cumulative oral morphine consumption at the end of the third postoperative day. Statistical analysis used univariate and multivariate step-by-step forward logistic regression models to determine risk factors associated with the main criteria. RESULTS Mean pain scores and morphine consumption were not significantly different between the 4 groups. In the multivariate analysis, the use of a continuous serratus plane block through a catheter was the only technique associated with a reduced incidence of high-dose oral morphine consumption (OR 0.09-95%CI [0.01-0.79], p = 0.03). CONCLUSION This study suggests that serratus plane block combined with continuous infusion through a catheter may have some benefits, although further studies are needed to confirm these results and determine the true place of the serratus plane block in pain management after VATS for pneumothorax.
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Affiliation(s)
- Pierre-Antoine Allain
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Michele Carella
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Apostolos C Agrafiotis
- Service de chirurgie thoracique, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Julien Burey
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Faculté de médecine Sorbonne Université (Paris VI), Paris, France
| | - Jalal Assouad
- Service de chirurgie thoracique, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Faculté de médecine Sorbonne Université (Paris VI), Paris, France
| | - El-Mahdi Hafiani
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Yacine Ynineb
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Francis Bonnet
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Faculté de médecine Sorbonne Université (Paris VI), Paris, France
| | - Marc Garnier
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,Faculté de médecine Sorbonne Université (Paris VI), Paris, France.
| | - Christophe Quesnel
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, AP-HP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Faculté de médecine Sorbonne Université (Paris VI), Paris, France
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11
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Duclos G, Resseguier N, Ronfle R, Thomas PA, Leone M. Complemental analysis about postoperative opioid consumption between video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) for early-stage lung cancer. J Thorac Dis 2018; 10:E764-E765. [PMID: 30505522 DOI: 10.21037/jtd.2018.09.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gary Duclos
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille 13015, France
| | - Noemie Resseguier
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille, Marseille 13385, France
| | - Romain Ronfle
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille 13015, France
| | - Pascal-Alexandre Thomas
- Service de chirurgie thoracique et de l'oesophage, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille 13015, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille 13015, France
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Bayman EO, Brennan TJ. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery and postoperative opioid consumption. J Thorac Dis 2018; 10:S3222-S3223. [PMID: 30370119 DOI: 10.21037/jtd.2018.08.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emine Ozgur Bayman
- Departments of Anesthesia and Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Timothy J Brennan
- Departments of Anesthesia and Pharmacology, University of Iowa, Iowa City, IA, USA
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