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Wang Y, Sun Q, Huang Y, Yang Q, Chen R, Zhang X, Zhao X, Wang M. Continuous Analgesia with Intercostal Catheterization after Thoracoscopy. Thorac Cardiovasc Surg 2024; 72:476-482. [PMID: 37673104 DOI: 10.1055/a-2168-9081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND There are few studies on continuous intercostal nerve block after single operation hole thoracoscopic surgery, that is, two-port thoracoscopic surgery. OBJECTIVE To evaluate the analgesic effect of continuous intercostal nerve block after thoracoscopic surgery. METHODS A total of 80 patients who underwent single operation hole thoracoscopic surgery in our hospital between September 2020 and June 2021 were enrolled and divided into two groups. Based on basic analgesia, an intercostal catheter was placed during the operation for continuous intercostal block analgesia after the operation in the experimental group (group A, n = 40). The control group (group B, n = 40) was treated with sufentanil intravenous analgesia after surgery, which is namely "basic analgesia." The postoperative pain scores, restlessness during the recovery period, effect on reducing opioid use, postoperative chest complications, patient satisfaction, etc., were compared between the two groups. RESULTS The pain scores of patients in group A were significantly lower compared with those in group B at 12, 24, 36, and 48 hours after surgery (3.325 ± 1.163 vs. 4.550 ± 1.176, 2.650 ± 1.001 vs. 4.000 ± 1.038, 2.325 ± 0.917 vs. 3.700 ± 0.966, and 1.775 ± 1.050 vs. 3.150 ± 1.075, p < 0.001, respectively). Sufentanil consumption in group A was significantly lower than in group B at 48 hours after surgery (98.625 ± 4.158 vs. 106.000 ± 7.228, p < 0.001). CONCLUSION Multimodal analgesia is ideal for early pain control after thoracotomy. A continuous intercostal nerve block can effectively reduce postoperative pain in patients.
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Affiliation(s)
- Yifei Wang
- Department of Thoracic Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Sun
- Department of Thoracic Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yiling Huang
- Department of Nursing, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qinghua Yang
- Department of Cardiovascular Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong Chen
- Department of Nursing, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xianwei Zhang
- Department of Thoracic Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuewei Zhao
- Department of Thoracic Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingdong Wang
- Department of Thoracic Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Gao X, Wang S, Li Y, Zhou D, Peng X. Clinical Analysis of Different Anesthesia and Analgesia Methods for Patients Undergoing Uniportal Video-assisted Lung Surgery. Clin Ther 2024; 46:570-575. [PMID: 39039005 DOI: 10.1016/j.clinthera.2024.06.009] [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: 04/23/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE The purpose of this study was to compare 3 intraoperative modalities to determine the best and most convenient one for pain control for uniportal lung surgery. This study compared general anesthesia with serratus plane block, general anesthesia with epidural, and general anesthesia alone to examine postoperative pain scores in patients. METHODS Eighty patients were enrolled and statistically analyzed. Three interventions were studied: general anesthesia with serratus plane block (group S), general anesthesia with thoracic epidural (group E), and general anesthesia only (group G). Outcome measures compared among the 3 groups included demographic characteristics; surgical types; anesthesia and operative time; postoperative pain scores; vital signs; morphine consumption at 0, 2, and 6 hours and day 1 and day 2 after surgery; incidence of opioid-related adverse events and chronic pain; hospital length of stay (LOS); and overall expenses. The numerical rating scale was used to assess the degree of pain on the first and second postoperative days. Postoperative morphine consumption, incidence of opioid-related side effects, hospital LOS, and overall hospital expenses were documented, as well as incidence of chronic postoperative pain. FINDINGS There was no difference in the incidence of opioid-related adverse events and chronic pain, hospital LOS, and overall expenses among the 3 groups. After investigating factors that may influence hospital LOS and overall expenses, the multivariable analysis indicated that only longer operative time was associated with longer hospital stay and more hospital expenses. IMPLICATIONS This prospective study found that general anesthesia alone offers an easy and efficient approach resulting in similar postoperative pain scores and morphine consumption compared with nerve block and epidural. Longer operative time was associated with longer hospital stay and more hospital expenses. CLINICALTRIALS gov identifier: NCT03839160. (Clin Ther. 2024;XX:XXX-XXX) © 2024 Elsevier HS Journals, Inc.
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Affiliation(s)
- Xuan Gao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Shuwei Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yi Li
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Di Zhou
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuemei Peng
- Department of Anesthesiology, Shanghai Wusong Hospital, Shanghai, China
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Xu X, Xie YX, Zhang M, Du JH, He JX, Hu LH. Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial. Pain Ther 2024; 13:577-588. [PMID: 38592611 PMCID: PMC11111614 DOI: 10.1007/s40122-024-00593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer. METHODS In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48 h post operation, and the incidence of postoperative adverse reactions were compared between the two groups. RESULTS The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7 min, t = - 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ2 = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = - 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48 h post operation than at 2, 6, 12, and 24 h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24 h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups. CONCLUSIONS Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery. TRIAL REGISTRATION https://www.chictr.org.cn , identifier ChiCTR2300072005, prospectively registered on 31/05/2023.
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Affiliation(s)
- Xia Xu
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Ying-Xin Xie
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Meng Zhang
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Jian-Hui Du
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Jin-Xian He
- Department of Thoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning road, Ningbo, 315040, People's Republic of China
| | - Li-Hong Hu
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China.
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Ramjit S, Davey MG, Loo C, Moran B, Ryan EJ, Arumugasamy M, Robb WB, Donlon NE. Evaluating analgesia strategies in patients who have undergone oesophagectomy-a systematic review and network meta-analysis of randomised clinical trials. Dis Esophagus 2024; 37:doad074. [PMID: 38221857 DOI: 10.1093/dote/doad074] [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: 09/28/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
Optimal pain control following esophagectomy remains a topic of contention. The aim was to perform a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) evaluating the analgesia strategies post-esophagectomy. A NMA was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using Shiny and R. Fourteen RCTs which included 565 patients and assessed nine analgesia techniques were included. Relative to systemic opioids, thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): -13.73, 95% Confidence Interval (CI): -27.01-0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: -36.2, 95% CI: -61.44-10.96) (n = 569, 15 RCTs) and dynamic (MD: -42.90, 95% CI: -68.42-17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: -13.05, 95% CI: -22.74-3.36) and dynamic (MD: -18.08, 95% CI: -31.70-4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: -33.20, 95% CI: -60.57-5.83) and 48 hours (MD: -42.66, 95% CI: -59.45-25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: -5.00, 95% CI: -6.82-3.18) and time to extubation (MD: -4.40, 95% CI: -5.91-2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91-18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87-26.87). TEA provides optimal pain control and improved post-operative respiratory function in patients post-esophagectomy, reducing ICU stays, one of the benchmarks of improved post-operative recovery. IPA demonstrates promising results for potential implementation in the future following esophagectomy.
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Affiliation(s)
- Sinead Ramjit
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitlyn Loo
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendan Moran
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eanna J Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - William B Robb
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel E Donlon
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Li J, Liu J, Zhang M, Wang J, Liu M, Yu D, Rong J. Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study. Brain Behav 2024; 14:e3379. [PMID: 38376027 PMCID: PMC10772846 DOI: 10.1002/brb3.3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences. AIMS This study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD. METHODS A total of 279 patients aged ≥60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet-to-white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC). RESULTS In total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively. CONCLUSION The TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery.
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Affiliation(s)
- Jianli Li
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Jing Liu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
- Graduate FacultyHebei North UniversityZhangjiakou CityChina
| | - Mingming Zhang
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Jing Wang
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Meinv Liu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Dongdong Yu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Junfang Rong
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
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Patel A, Shah A, Apigo A, Lin HM, Ouyang Y, Huang K, Friedman S, Yimen M, Puskas JD, Bhatt HV. Perioperative Implementation of Low-Dose Pregabalin in an Enhanced Recovery After Cardiac Surgery Protocol: A Pre-Post Observational Study. J Cardiothorac Vasc Anesth 2024; 38:183-188. [PMID: 37940456 DOI: 10.1053/j.jvca.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Determine the effect of low-dose pregabalin in the perioperative enhanced recovery after cardiac surgery protocol. DESIGN Pre-post observational study. SETTING Tertiary care hospital. PARTICIPANTS Patients undergoing off-pump coronary artery bypass graft procedures. INTERVENTIONS Pregabalin 75 mg BID for 48 hours postoperatively versus no pregabalin in a perioperative setting. MEASUREMENTS AND MAIN RESULTS Perioperative opioid use, pain scores, length of stay, time to extubation, and mortality were all measured. Descriptive data were presented as mean (SD), median (IQR), or N (%). Ordinal and continuous data used the t-test or Kruskal-Wallis test. Categorical data were compared between groups using the chi-square test or Fisher's exact test, as appropriate. Low-dose pregabalin administration (75 mg twice daily for 48 hours after surgery) was associated with a clinically significant reduction in opioid consumption on postoperative day 0 by 30.6%, with a median requirement of 318 (233, 397) morphine milligram equivalents (MME) in the pregabalin group compared with 458 (375, 526) MME in the control group (p < 0.001). There was no significant difference in pain scores between the groups with the exception at 0-to-12 hours, during which the pregabalin group had greater pain scores (median 3.32 [1.65, 4.36] v 2.0 [0, 3.25], p = 0.013) (Table 3). Moreover, there was no significant difference in pain scores on postoperative day 1 (p = 0.492), day 2 (p = 0.442), day 3 (p = 0.237), and day 4 (p = 0.649). The difference in average Richmond Agitation Sedation Score scores was also not statistically significant between groups at 12 hours (p = 0.954) and at 24 hours (p = 0.301). The pregabalin group had no increased incidence of adverse events or any significant differences in intensive care unit length of stay, time to extubation, or mortality. CONCLUSIONS In this evaluation of perioperative pregabalin administration for patients requiring cardiac surgery, pregabalin reduced postoperative opioid use, with significant reductions on postoperative day 0, and without any significant increase in adverse reactions. However, no differences in intensive care unit length of stay, time to extubation, or mortality were noted. The implementation of low-dose perioperative pregabalin within an Enhanced Recovery After Cardiac Surgery protocol may be effective at reducing postoperative opioid use in the immediate postoperative period, and may be safe with regard to adverse events. Ideal dosing strategies have not been determined; thus, further randomized control trials with an emphasis on limiting confounding factors need to be conducted.
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Affiliation(s)
- Alopi Patel
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside Medical Center, New York, NY.
| | - Ami Shah
- Department of Pharmacy, Mount Sinai Morningside Medical Center, New York, NY; Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - Anthony Apigo
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside Medical Center, New York, NY
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Yuxia Ouyang
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY
| | - Kristy Huang
- Department of Pharmacy, Mount Sinai Morningside Medical Center, New York, NY
| | - Seana Friedman
- Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - Mekeleya Yimen
- Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - John D Puskas
- Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside Medical Center, New York, NY
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Ponholzer F, Schweiger T, Ghanim B, Maier H, Hutter J, Tomaselli F, Krause A, Müller M, Lindenmann J, Spruk G, Augustin F. Analysis of Pain Management after Anatomic VATS Resection in Austrian Thoracic Surgery Units. J Clin Med 2023; 13:80. [PMID: 38202087 PMCID: PMC10779807 DOI: 10.3390/jcm13010080] [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: 11/06/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic surgery units, with a special interest in opioid usage and strategies to avoid opioids. METHODS A questionnaire was designed to assess the use of regional anesthesia, postoperative pain medication and characteristics of individual pain management regimens. The questionnaire was sent to all thoracic surgery units in Austria, with nine out of twelve departments returning them. RESULTS All departments use regional anesthesia during the procedure. Four out of nine centers use epidural analgesia or an intercostal catheter for postoperative regional anesthesia in at least 50% of patients. Two departments follow an opioid restrictive regimen, five depend on the visual analogue scale (VAS) and two administer opioids on a fixed schedule. Three out of nine departments use NSAIDs on a fixed schedule. The most used medication is metamizole (eight out of nine centers; six on a fixed schedule, two depending on VAS) followed by piritramide (six out of nine centers; none as a fixed prescription). CONCLUSIONS This study reflects the heterogeneity in postoperative pain treatment after VATS anatomic lung resections. All departments use some form of regional anesthesia in the perioperative period; prolonged regional anesthesia is not utilized uniformly to reduce opioid consumption, as suggested in enhanced recovery after surgery programs. More evidence is needed to optimize and standardize postoperative pain treatment.
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Affiliation(s)
- Florian Ponholzer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (H.M.)
| | - Thomas Schweiger
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Bahil Ghanim
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria;
| | - Herbert Maier
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (H.M.)
| | - Jörg Hutter
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Florian Tomaselli
- Department of Cardiac-, Vascular-, and Thoracic Surgery, Johannes Kepler University Linz, 4020 Linz, Austria
| | - Axel Krause
- Department of Surgery, Elisabethinen Hospital, 4020 Linz, Austria
| | - Michael Müller
- Department of Thoracic Surgery, Clinic Floridsdorf, 1210 Vienna, Austria;
| | - Jörg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, 8010 Graz, Austria
| | - Gero Spruk
- Department of Cardiac-, Thoracic- and Vascular Surgery, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt, Austria;
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (H.M.)
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Li XT, Yang WH, Xue FS. Several key issues must be noted in determining postoperative analgesic efficacy of intercostal nerve block for thoracoscopic surgery. J Cardiothorac Surg 2023; 18:350. [PMID: 38041155 PMCID: PMC10693072 DOI: 10.1186/s13019-023-02456-2] [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: 05/23/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
The letter to the editor was written in response to "The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial", which was recently published by Li et al. (J Cardiothorac Surg 18(1):128, 2023). In this article, Li et al. showed that addition of a preoperative intercostal nerve block to the multimodal analgesic strategy significantly reduced the pain scores within 48 h after surgery. However, we noted several issues in this study that were not well addressed. They were no use of a standard opioid-sparing multimodal analgesic strategy recommended in the current Enhanced Recovery After Surgery protocols for thoracic surgery, the lack of clear description for reasonable selection of rescue analgesics, the interpretion of between-group differences in the postoperative pain scores based on only statistical differences rather than clinically meaningful differences, inclusion of patients who were not blinded to study intervention, not reporting cumulative opioid consumption and complications of intercostal nerve block. We believe that clarification of these issues is not only useful for improving design quality of randomized clinical trials which assess postoperative analgesic efficacy of nerve blocks, but also is helpful for the readers who want to use an opioid-sparing multimodal protocol including a nerve block in patients undergoing thoracoscopic surgery.
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Affiliation(s)
- Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Wen-He Yang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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Spaans LN, van Steenwijk QCA, Seiranjan A, Janssen N, de Loos ER, Susa D, Eerenberg JP, Bouwman RA(A, Dijkgraaf MG, van den Broek FJC. Pain management after pneumothorax surgery: intercostal nerve block or thoracic epidural analgesia. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad180. [PMID: 37941433 PMCID: PMC10645434 DOI: 10.1093/icvts/ivad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES In patients undergoing video-assisted thoracoscopic surgery for pneumothorax, the benefits and risks of single-shot intercostal nerve block as loco-regional analgesia are not well known. We retrospectively compared the effectiveness of intercostal nerve blocks as a viable alternative to thoracic epidural analgesia (TEA) regarding pain control and enhanced recovery. METHODS A retrospective multicentre analysis with single-centre propensity score matching was performed in patients undergoing video-assisted thoracoscopic surgery for pneumothorax receiving either TEA or intercostal nerve block. The primary outcome was a proportion of pain scores ≥4 (scale 0-10) until postoperative day (POD) 3. Secondary outcomes included variation in pain over time, additional opioid use, length of stay, mobility, complications and recurrence rate. RESULTS In 218 patients, TEA was compared to intercostal nerve block and showed no difference in the proportion of pain scores ≥4 {14.3% [interquartile range (IQR) 0.0-33.3] vs 11.1% (IQR 0.0-27.3) respectively, P = 0.24}, more frequently needed additional opioids on the day of surgery (18% vs 48%) and first POD (20% vs 42%), had a shorter length of stay (4.0 days [IQR 3.0-7.0] vs 3.0 days [IQR 2.8-4.0]) and were significantly more mobile until POD 3, while having similar recurrences. Intercostal nerve block had higher pain scores early in the course whereas TEA had higher late (rebound) pain scores. CONCLUSIONS In a multimodal analgesic setting with additional opioids, intercostal nerve block shows comparable moments of unacceptable pain from POD 0-3 compared to TEA and is linked to improved mobility. Results require randomized confirmation.
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Affiliation(s)
- Louisa N Spaans
- Department of Surgery, Maxima Medical Center, Eindhoven, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, Netherlands
| | | | - Adelina Seiranjan
- Department of Surgery, Maxima Medical Center, Eindhoven, Netherlands
| | - Nicky Janssen
- Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Erik R de Loos
- Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Denis Susa
- Department of Surgery, Bravis Hospital, Bergen op Zoom, Netherlands
| | - Jan P Eerenberg
- Department of Surgery, Tergooi Medical Centre, Hilversum, Netherlands
| | - R A (Arthur) Bouwman
- Department of Anesthesiology and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven Technical University, Eindhoven, Netherlands
| | - Marcel G Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, Netherlands
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Allman R, Speicher J. Pain Management Protocol-Techniques and Medication Components. Ann Thorac Surg 2023; 116:653. [PMID: 37054931 DOI: 10.1016/j.athoracsur.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Robert Allman
- Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, 115 Heart Dr, Greenville, NC 27834
| | - James Speicher
- Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, 115 Heart Dr, Greenville, NC 27834.
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Saikat S, Shweta S, Somalia M, Dibyendu K, Sushan M. Comparative efficacy of serratus anterior plane block (SAPB) and fentanyl for postoperative pain management and stress response in patients undergoing minimally invasive cardiac surgery (MICS). Ann Card Anaesth 2023; 26:268-273. [PMID: 37470524 PMCID: PMC10451145 DOI: 10.4103/aca.aca_91_22] [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: 05/18/2022] [Revised: 06/12/2022] [Accepted: 07/09/2022] [Indexed: 07/21/2023] Open
Abstract
Background Fast-tracking plays a significant role in reducing perioperative morbidity and postoperative hospital stay by facilitating early extubation and optimal pain control. Attenuating the stress response to surgery also has a crucial function in enhancing recovery. Serratus anterior plane block (SAPB) is a recently described technique for chest wall analgesia. More data is required to find out the effectiveness of analgesia by SAPB for minimally invasive cardiac surgery (MICS). Aim The study aimed to assess the efficacy and safety of ultrasound-guided SAPB compared to fentanyl for controlling post-thoracotomy pain and stress response in patients undergoing MICS. Setting and Design Time framed comparative, prospective, and observational study. Materials and Methods Patients undergoing MICS for coronary artery bypass grafting under general anesthesia were randomly assigned into two groups. SAPB group (Group A) patients were given 0.2% of 20 ml ropivacaine followed by catheter insertion for continuous infiltration at the end of the procedure. Fentanyl group (Group B) patients were given fentanyl infusion for postoperative analgesia. The primary outcome measured changes in visual analog scale (VAS) score (pain) and cortisol levels (for stress response) in both groups. Results VAS score was significantly low in Group A when compared to Group B (P < 0.0001). Cortisol levels were also lower in the SAPB group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, pulse rate, and oxygen saturation) were more stable in Group A with a lesser requirement of top-up analgesics. Conclusion SAPB was more effective than fentanyl in managing post-thoracotomy pain after MICS. Cortisol level was lower in the group that received SAPB.
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Affiliation(s)
- Sengupta Saikat
- Senior Consultant Anesthesiologist, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
| | - Singh Shweta
- Resident, Department of Anesthesiology, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
| | - Mukherjee Somalia
- Senior Registrar, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
| | - Khan Dibyendu
- Consultant Cardiac Anesthesiologist, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
| | - Mukhopadhyay Sushan
- Consultant Cardiac Surgeon, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
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Oh C, Chong Y, Kang MW, Bae J, Lee S, Jo Y, Lee J, Baek S, Jung J, Kim YH, Hong B. Comparison between costotransverse foramen block and thoracic paravertebral block for VATS pulmonary resection: A randomized noninferiority trial. J Clin Anesth 2023; 88:111127. [PMID: 37207551 DOI: 10.1016/j.jclinane.2023.111127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
STUDY OBJECTIVE The present study assessed whether costotransverse foramen block (CTFB) is noninferior to thoracic paravertebral block (TPVB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS) pulmonary resection. DESIGN Single-center, double-blinded, randomized, non-inferiority trial. SETTING Operating room and intensive care unit or ward in a tertiary hospital. PATIENTS Patients aged 20 to 80 years with American Society of Anesthesiology physical status 1 to 3 scheduled for elective VATS pulmonary resection. INTERVENTIONS Sixty patients were randomly allocated 1:1 to receive CTFB or TPVB using 15 mL aliquots of 0.5% ropivacaine at the T4-5 and T6-7 intercostal levels immediately after the induction of general anesthesia. MEASUREMENTS The primary outcome was the area under the curve (AUC) of numeric rating scale (NRS, 0 to 10) during 24 h postoperatively (noninferiority limit was 24; NRS 1 per hour). The secondary outcomes included postoperative opioid consumption, rescue analgesic use, postoperative nausea and vomiting, pulmonary function, dermatomal spread of the blockade, and quality of recovery. MAIN RESULTS Forty-seven patients were included for final analysis. The difference between the mean 24-h AUCs of NRS in the CTFB (34.25 ± 16.30, n = 24) and TPVB (39.52 ± 17.13, n = 23) groups was -5.27 (95% confidence interval [CI], -15.09 to 4.55), with the upper limit of 95% CI being far below the predefined noninferiority margin of 24. There was no significant difference in the dermatomal spread of the blockades between the groups, as both reached the upper and lower most levels of T3 and T7 (median). Additionally, there were no significant differences in other secondary outcomes between the two groups. CONCLUSIONS The analgesic effect of CTFB was noninferior to that of TPVB during 24 h postoperatively in VATS pulmonary resection. Moreover, CTFB may offer potential safety benefits by keeping the tip of the needle far from the pleura and vascular structure.
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yooyoung Chong
- Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Min-Woong Kang
- Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jaemun Bae
- Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jiyong Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sujin Baek
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jinsik Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
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Li S, Feng J, Fan K, Fan X, Cao S, Zhang G. The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial. J Cardiothorac Surg 2023; 18:128. [PMID: 37041525 PMCID: PMC10091630 DOI: 10.1186/s13019-023-02210-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Intercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery. METHODS 126 patients, aged 18-70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded. RESULTS VAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004). CONCLUSIONS For patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage. TRIAL REGISTRATION Chinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019.
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Affiliation(s)
- Shuo Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Jinteng Feng
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Kun Fan
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Xiaoe Fan
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Shaoning Cao
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
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Spaans LN, Bousema JE, Meijer P, Bouwman RA(A, van den Broek R, Mourisse J, Dijkgraaf MGW, Verhagen AFTM, van den Broek FJC. Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6978197. [PMID: 36802255 PMCID: PMC9931052 DOI: 10.1093/icvts/ivad003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding postoperative analgesia. We performed a systematic review and meta-analysis to determine the mean pain scores of different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia and only systemic analgesia) after thoracoscopic anatomical lung resection. METHODS Medline, Embase and Cochrane databases were searched until 1 October 2022. Patients undergoing at least >70% anatomical resections through thoracoscopy reporting postoperative pain scores were included. Due to a high inter-study variability an explorative meta-analysis next to an analytic meta-analysis was performed. The quality of evidence has been evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS A total of 51 studies comprising 5573 patients were included. Mean 24, 48 and 72 h pain scores with 95% confidence interval on a 0-10 scale were calculated. Length of hospital stay, postoperative nausea and vomiting, additional opioids and the use of rescue analgesia were analysed as secondary outcomes. A common-effect size was estimated with an extreme high heterogeneity for which pooling of the studies was not appropriate. An exploratory meta-analysis demonstrated acceptable mean pain scores of Numeric Rating Scale <4 for all analgesic techniques. CONCLUSIONS This extensive literature review and attempt to pool mean pain scores for meta-analysis demonstrates that unilateral regional analgesia is gaining popularity over thoracic epidural analgesia in thoracoscopic anatomical lung resection, despite great heterogeneity and limitations of current studies precluding such recommendations. PROSPERO REGISTRATION ID number 205311.
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Affiliation(s)
- Louisa N Spaans
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - Jelle E Bousema
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - Patrick Meijer
- Department of Anesthesiology, Máxima Medical Center, Veldhoven, Netherlands
| | - R A (Arthur) Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Renee van den Broek
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Jo Mourisse
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank J C van den Broek
- Corresponding author. Department of Surgery, Máxima MC, PO Box 7777, 5500 MB Veldhoven, Netherlands. Tel: +31-040-8888550; e-mail: (F.J.C. van den Broek)
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15
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Spaans LN, Dijkgraaf MGW, Meijer P, Mourisse J, Bouwman RA, Verhagen AFTM, van den Broek FJC. Optimal postoperative pain management after VATS lung resection by thoracic epidural analgesia, continuous paravertebral block or single-shot intercostal nerve block (OPtriAL): study protocol of a three-arm multicentre randomised controlled trial. BMC Surg 2022; 22:330. [PMID: 36058900 PMCID: PMC9441091 DOI: 10.1186/s12893-022-01765-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate pain control after video-assisted thoracoscopic surgery (VATS) for lung resection is important to improve postoperative mobilisation, recovery, and to prevent pulmonary complications. So far, no consensus exists on optimal postoperative pain management after VATS anatomic lung resection. Thoracic epidural analgesia (TEA) is the reference standard for postoperative pain management following VATS. Although the analgesic effect of TEA is clear, it is associated with patient immobilisation, bladder dysfunction and hypotension which may result in delayed recovery and longer hospitalisation. These disadvantages of TEA initiated the development of unilateral regional techniques for pain management. The most frequently used techniques are continuous paravertebral block (PVB) and single-shot intercostal nerve block (ICNB). We hypothesize that using either PVB or ICNB is non-inferior to TEA regarding postoperative pain and superior regarding quality of recovery (QoR). Signifying faster postoperative mobilisation, reduced morbidity and shorter hospitalisation, these techniques may therefore reduce health care costs and improve patient satisfaction. METHODS This multi-centre randomised study is a three-arm clinical trial comparing PVB, ICNB and TEA in a 1:1:1 ratio for pain (non-inferiority) and QoR (superiority) in 450 adult patients undergoing VATS anatomic lung resection. Patients will not be eligible for inclusion in case of contraindications for TEA, PVB or ICNB, chronic opioid use or if the lung surgeon estimates a high probability that the operation will be performed by thoracotomy. PRIMARY OUTCOMES (1) the proportion of pain scores ≥ 4 as assessed by the numerical rating scale (NRS) measured during postoperative days (POD) 0-2; and (2) the QoR measured with the QoR-15 questionnaire on POD 1 and 2. Secondary outcome measures are cumulative use of opioids and analgesics, postoperative complications, hospitalisation, patient satisfaction and degree of mobility. DISCUSSION The results of this trial will impact international guidelines with respect to perioperative care optimization after anatomic lung resection performed through VATS, and will determine the most cost-effective pain strategy and may reduce variability in postoperative pain management. Trial registration The trial is registered at the Netherlands Trial Register (NTR) on February 1st, 2021 (NL9243). The NTR is no longer available since June 24th, 2022 and therefore a revised protocol has been registered at ClinicalTrials.gov on August 5th, 2022 (NCT05491239). PROTOCOL VERSION version 3 (date 06-05-2022), ethical approval through an amendment (see ethical proof in the Study protocol proof).
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Affiliation(s)
- L. N. Spaans
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - M. G. W. Dijkgraaf
- University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P. Meijer
- Department of Anesthesiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - J. Mourisse
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. A. Bouwman
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A. F. T. M. Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Wang L, Dong Y, Ji Y, Song W, Cheng C, Yang M, Che G. Clinical outcome and risk factors for subcutaneous emphysema in patients with lung cancer after video-assisted thorascopic surgery. Front Surg 2022; 9:956431. [PMID: 36117818 PMCID: PMC9478373 DOI: 10.3389/fsurg.2022.956431] [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: 05/30/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose With the clinical application of minimally invasive surgery and concept of enhanced recovery after surgery, the incidence of postoperative complications in lung cancer patients has been significantly reduced. However, postoperative subcutaneous emphysema (SE) becomes the main factor affecting the early discharge of patients. The aim of this study was to analyze the clinical outcome and risk factors for postoperative SE in lung cancer patients. Methods The clinical data of 414 lung cancer patients who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from September 2021 to December 2021 were prospectively collected. The incidence, severity and treatment of patients who had SE, surgery approach, application of drainage tube and clinical information were analyzed. Results The incidence rate of postoperative SE in patients with lung cancer was 33.09% (137/414) and mild cases accounted for the vast majority (30.19%, 125/414). Multivariate analysis indicated that male [odds ratio (OR) = 2.247, P = .014] and advanced age (OR = 1.021, P = .043) were main risk factors for postoperative SE in patients with lung cancer. Conservative treatment was the main treatment option for SE (98.5%, 135/137). The average hospital stay in the subcutaneous emphysema group (5.49 ± 4.41 days) was significantly longer than that in the non-subcutaneous emphysema group (4.44 ± 3.32 days) (P = .014) and no significant statistical difference in the average total hospital cost between the two groups (7,798.31 ± 1,414.85$ vs. 7,501.14 ± 1,605.18$, P = .072). Conclusion Postoperative SE in patients with minimally invasive lung cancer is mainly mild, and conservative treatment is appropriate for most cases.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingxian Dong
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Yanli Ji
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenpeng Song
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Chao Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Yang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Guowei Che
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
- Correspondence: Guowei Che
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Xu W, Dai W, Gao Z, Wang XS, Tang L, Pu Y, Yu Q, Yu H, Nie Y, Zhuang W, Qiao G, Cleeland CS, Shi Q. Establishment of Minimal Clinically Important Improvement for Patient-Reported Symptoms to Define Recovery After Video-Assisted Thoracoscopic Surgery. Ann Surg Oncol 2022; 29:5593-5604. [DOI: 10.1245/s10434-022-11629-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
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The Impact of Perioperative Multimodal Pain Management on Postoperative Outcomes in Patients (Aged 75 and Older) Undergoing Short-Segment Lumbar Fusion Surgery. Pain Res Manag 2022; 2022:9052246. [PMID: 35265235 PMCID: PMC8898790 DOI: 10.1155/2022/9052246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Abstract
Background Due to the presence of multimorbidity and polypharmacy, patients aged 75 and older are at a higher risk for postoperative adverse events after lumbar fusion surgery. More effective enhanced recovery pathway is needed for these patients. Pain control is a crucial part of perioperative management. The objective of this study is to determine the impact of multimodal pain management on pain control, opioid consumption, and other outcomes. Methods This is a retrospective review of a prospective collected database. Consecutive patients who underwent elective posterior lumbar fusion surgery (PLF) from October 2017 to April 2021 in our hospital were reviewed. Perioperative multimodal pain management (PMPM) group (from January 2019 to April 2021) in which patients received multimodal analgesia was case-matched to the control group (from October 2017 to December 2018) in which patients were treated under the conventional patient-controlled analgesia (PCA) method. Postoperative visual analogue scale (VAS), opioid consumption, complications within 3 months, and other outcomes were collected and compared between groups. Results A total of 122 consecutive patients (aged 75 and older) were included in the PMPM group and compared with previous 122 patients. The PMPM group had a lower maximal VAS score (3.0 ± 1.7 vs. 3.7 ± 2.0, p < 0.001) and frequency of additional opioid consumption (6.6% vs. 19.7%, p=0.001) on POD3 than the control group. The rates of postoperative complications were lower in the PMPM group compared with the control group (25% vs. 49%, p=0.006) during a 3-month follow-up period. Conclusions This study demonstrates that the PMPM protocol is effective in pain control and reducing additional opioid consumption when compared with conventional analgesia, even for patients aged 75 and older. Moreover, these improvements occur with a lower incidence of postoperative complications within three months after PLF surgery.
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19
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Lee A, Seyednejad N, Lawati YA, Mattice A, Anstee C, Legacy M, Gilbert S, Maziak DE, Sundaresan RS, Villeneuve PJ, Thompson C, Seely AJE. Evolution of Process and Outcome Measures during an Enhanced Recovery after Thoracic Surgery Program. J Chest Surg 2022; 55:118-125. [PMID: 35135904 PMCID: PMC9005934 DOI: 10.5090/jcs.21.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1–3, 4–6, and 7–9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1–3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4–6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7–9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7–9 months post-ERATS (p=0.06). Conclusion The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.
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Affiliation(s)
- Alex Lee
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nazgol Seyednejad
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Yaseen Al Lawati
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Mattice
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Caitlin Anstee
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Mark Legacy
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Donna E Maziak
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Ramanadhan S Sundaresan
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Patrick J Villeneuve
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Calvin Thompson
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew J E Seely
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
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Pierson M, Cretella B, Roussel M, Byrne P, Parkosewich J. A Nurse-Led Voiding Algorithm for Managing Urinary Retention After General Thoracic Surgery. Crit Care Nurse 2022; 42:23-31. [PMID: 35100628 DOI: 10.4037/ccn2022727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Untreated postoperative urinary retention (POUR) leads to bladder overdistension. Treatment of POUR involves urinary catheterization, which predisposes patients to catheter-associated urinary tract infections. The hospital's rate of POUR after lobectomy was 21%, exceeding the Society of Thoracic Surgeons' benchmark of 6.4%. Nurses observed that more patients were being catheterized after implementation of a newly revised urinary catheter protocol. OBJECTIVE To reduce the incidence of POUR by implementing a thoracic surgery-specific nurse-led voiding algorithm. METHODS Experts validated the voiding algorithm that standardized postoperative assessment. It was initiated after general thoracic surgery among 179 patients in a thoracic surgery stepdown unit of a large Magnet hospital. After obtaining verbal consent from patients, nurses collected demographic and clinical data and followed the algorithm, documenting voided amounts and bladder scan results. Descriptive statistics characterized the sample and the incidence of POUR. Associations were determined between demographic and clinical factors and POUR status by using the t test and χ2 test. RESULTS The POUR-positive group and the POUR-negative group were equivalent with regard to demographic and clinical factors, except more patients in the POUR-positive cohort had had a lobectomy (P = .05). The rate of POUR was 8%. Society of Thoracic Surgeons reports revealed a rapid and sustained reduction in the hospital's rates of POUR after lobectomy: from 21% to 3%. CONCLUSION The use of this nurse-led voiding algorithm effectively reduced and sustained rates of POUR.
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Affiliation(s)
- Mary Pierson
- Mary Pierson is the assistant nurse manager of the medical intensive care stepdown unit, Yale New Haven Hospital. At the time this article was written, she was the assistant nurse manager of the 5-4 thoracic stepdown unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Brittany Cretella
- Brittany Cretella is a casual status clinical nurse on the 5-4 thoracic stepdown unit, Heart and Vascular Center, Yale New Haven Hospital
| | - Maureen Roussel
- Maureen Roussel is the clinical nurse specialist for cardiothoracic surgery, Heart and Vascular Center, Yale New Haven Hospital
| | - Patricia Byrne
- Patricia Byrne is the patient services manager of the 5-4 thoracic stepdown unit, Heart and Vascular Center, Yale New Haven Hospital
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21
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Zengin M, Sazak H, Baldemir R, Ulger G, Alagoz A. The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2022; 36:2991-2999. [DOI: 10.1053/j.jvca.2022.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
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22
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Role of Dexmedetomidine in Early POCD in Patients Undergoing Thoracic Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8652028. [PMID: 34859103 PMCID: PMC8632391 DOI: 10.1155/2021/8652028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/01/2021] [Indexed: 02/05/2023]
Abstract
Objective To evaluate whether a low-dose perioperative infusion of Dex reduces early POCD. Design This study was a double-blind, randomized, placebo-controlled trial that randomly assigned patients to Dex or saline placebo infused during surgery and patient-controlled intravenous analgesia (PCIA) infusion. Patients were assessed for postoperative cognitive decline. Interventions. Dex was infused at a loading dose of 0.5 μg/kg intravenously (15 min after entering the operation room) followed by a continuous infusion at a rate of 0.5 μg/kg/h until one-lung ventilation or artificial pneumothorax ended. Patients in the Dex group received regular PCIA pump with additional dose of Dex (200 μg). Results In total, 126 patients were randomized, and 102 patients were involved in the result analysis. The incidence of POCD was 36.54% (19/52) in the Dex group and 32.00% (16/50) in the normal saline (NS) group, with no statistic difference. No significant difference was observed between the two groups in terms of Telephone Interview for Cognitive Status-Modified (TICS-m) scores at different times. However, the TICS-m score at 7 days after surgery was significantly lower than that at 30 days in 102 patients (32.93 ± 0.42 vs. 33.92 ± 0.47, P = 0.03). The visual analogue scale scores in the Dex group were significantly lower than those in the NS group 1 day postoperation at rest and activity (2.00 [1.00-3.00] vs. 3.00 [2.00-4.00], P < 0.01; 4.00 [3.00-5.00] vs. 5.00 [4.00-6.00], P < 0.05, respectively). Patients receiving Dex or NS had no statistical difference in activities of daily living (ADLs) scores at 7 and 30 days after surgery, but the ADL score at 30 days after surgery showed a significant reduction compared with that at 7 days (P < 0.01). Patients in the Dex group had a shorter hospital length of stay (15.26 ± 3.77 vs. 17.69 ± 5.09, P = 0.02) and less expenses (52458.71 ± 10649.30 vs. 57269.03 ± 9269.98, P = 0.04) than those in the NS group. Conclusions Low-dose Dex in the perioperative period did not reduce the incidence of early POCD in thoracic surgery. However, it relieved postoperative pain, decreased the hospitalization expenses, and shortened the length of stay.
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Prokopowicz A, Byrka K. Effectiveness of mental simulations on the early mobilization of patients after cesarean section: a randomized controlled trial. Sci Rep 2021; 11:22634. [PMID: 34811410 PMCID: PMC8608872 DOI: 10.1038/s41598-021-02036-1] [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: 05/27/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate whether psychological intervention (single mental simulation) among women after cesarean surgery (CC) can affect their willingness to verticalize, actual verticalization, and the duration of the first mobilization. In this prospective randomised, controlled study, 150 women after CC were divided into 3 groups: experimental group with process-simulation with elements of relaxation, experimental group with outcome-simulation with elements of relaxation and control group with elements of relaxation only. After a 5-h stay in the post-operative room, women listened to a recording with a stimulation. Pain and anxiety of verticalization were measured before and after listening to the recording and after verticalization. Almost 12% more patients verticalized in the process-simulation group than in the control group. Percentages of mobilized patients were: 39.4% the process-simulation group; 32.8% in the outcome-simulation group; 27.7% controls (p = 0.073). Mobilization was 5 min longer in the process-simulation group then in control (p < 0.01). Anxiety after the simulation was a significant covariate of the willingness to verticalize, actual verticalization and time spent in mobilization. We conclude that a single mental simulation can effectively motivate patients for their first verticalization after CC. Perceived anxiety before verticalization may affect the effectiveness of interventions, so we recommend to check it at the postoperative care. ClinicalTrials.gov Identifier: NCT04829266.
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Affiliation(s)
- Anna Prokopowicz
- Division of Midwifery and Gynaecological Nursing, Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, ul. Kazimierza Bartla 5, 50-996, Wrocław, Poland. .,Department of Gynecology and Obstetrics, University Hospital in Wroclaw, Wrocław, Poland.
| | - Katarzyna Byrka
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wrocław, Poland
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Mijatovic D, Bhalla T, Farid I. Post-thoracotomy analgesia. Saudi J Anaesth 2021; 15:341-347. [PMID: 34764841 PMCID: PMC8579496 DOI: 10.4103/sja.sja_743_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 11/05/2022] Open
Abstract
Thoracotomy is considered one of the most painful operative procedures. Due to anatomical complexity, post-thoracotomy pain requires multimodal perioperative treatment to adequately manage to ensure proper postoperative recovery. There are several different strategies to control post-thoracotomy pain including interventional techniques, such as neuraxial and regional injections, and conservative treatments including medications, massage therapy, respiratory therapy, and physical therapy. This article describes different strategies and evidence base for their use.
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Affiliation(s)
- Desimir Mijatovic
- Pain Center, Akron Children's Hospital, Department of Anesthesia and Pain Medicine, Akron, Ohio, USA
| | - Tarun Bhalla
- Pain Center, Akron Children's Hospital, Department of Anesthesia and Pain Medicine, Akron, Ohio, USA
| | - Ibrahim Farid
- Pain Center, Akron Children's Hospital, Department of Anesthesia and Pain Medicine, Akron, Ohio, USA
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25
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Ankeny D, Chitilian H, Bao X. Anesthetic Management for Pulmonary Resection: Current Concepts and Improving Safety of Anesthesia. Thorac Surg Clin 2021; 31:509-517. [PMID: 34696863 DOI: 10.1016/j.thorsurg.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasingly complex procedures are routinely performed using minimally invasive approaches, allowing cancers to be resected with short hospital stays, minimal postsurgical discomfort, and improved odds of cancer-free survival. Along with these changes, the focus of anesthetic management for lung resection surgery has expanded from the provision of ideal surgical conditions and safe intraoperative patient care to include preoperative patient training and optimization and postoperative pain management techniques that can impact pulmonary outcomes as well as patient lengths of stay.
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Affiliation(s)
- Daniel Ankeny
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Hovig Chitilian
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xiaodong Bao
- Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Lewis TC, Sureau K, Katz A, Fargnoli A, Lesko M, Rudym D, Angel LF, Chang SH, Kon ZN. Multimodal opioid-sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block. Clin Transplant 2021; 36:e14512. [PMID: 34658078 DOI: 10.1111/ctr.14512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
Opioid analgesics are commonly used post-lung transplant, but have many side effects and are associated with worse outcomes. We conducted a retrospective review of all lung transplant recipients who were treated with a multimodal opioid-sparing pain protocol. The use of liposomal bupivacaine intercostal nerve block was variable due to hospital restrictions. The primary objective was to describe opioid requirements and patient-reported pain scores early post-lung transplant and to assess the impact of intraoperative liposomal bupivacaine intercostal nerve block. We treated 64 lung transplant recipients with our protocol. Opioid utilization decreased to a mean of 43 milligram oral morphine equivalents by postoperative day 4. Median pain scores peaked at 4 on postoperative day 1 and decreased thereafter. Only three patients were discharged home with opioids, all of whom were taking opioid agonist therapy pre-transplant for opioid use disorder. Patients who received liposomal bupivacaine intercostal nerve block in the operating room had a significant reduction in opioid consumption over postoperative day 1 through 4 (228 mg vs. 517 mg, P= .032). A multimodal opioid-sparing pain management protocol is feasible and resulted in weaning of opioids prior to hospital discharge.
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Affiliation(s)
- Tyler C Lewis
- Department of Pharmacy, NYU Langone Health, New York, New York, USA.,Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Kimberly Sureau
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Alyson Katz
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | - Anthony Fargnoli
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Melissa Lesko
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Darya Rudym
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Luis F Angel
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, Northwell Health, Manhasset, New York, USA
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Cavaleri M, Tigano S, Nicoletti R, La Rosa V, Terminella A, Cusumano G, Sanfilippo F, Astuto M. Continuous Erector Spinae Plane Block as Postoperative Analgesic Technique for Robotic-Assisted Thoracic Surgery: A Case Series. J Pain Res 2021; 14:3067-3072. [PMID: 34629899 PMCID: PMC8495611 DOI: 10.2147/jpr.s308027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction The erector spinae plane block (ESPB) is a recently implemented analgesic technique initially reported for thoracic analgesia and subsequently adopted for both intra- and postoperative pain management. Thoracic surgery is among the most painful surgical procedures, even when conducted with minimally invasive approach. Robotic-assisted thoracic surgery (RATS) challenges the traditional analgesic regimens as one of its aims is to decrease the patient’s length of stay (LOS) whilst achieving optimal postoperative pain management. Furthermore, there is lots of growing evidence on the impact of poorly controlled postoperative pain (PP) on the development of chronic post-surgical pain (CPSP). In these case series, we aim to describe our preliminary experience of postoperative pain management with continuous ESPB in the field of RATS. Case Series Presentation In eight consecutive patients undergoing elective RATS procedure, we performed the ESPB after surgery with an initial bolus of local anesthetic followed by catheter insertion for continuous infusion. The infusion of local anesthetic lasted for the first two postoperative days. The effectiveness of the ESPB was evaluated through serial pain assessment with numeric rate scale (NRS) score, both at rest and during movement every 6 hours. Any analgesic rescue drug prescription was reported. We noted that the ESPB strongly reduced the prescription of opioids and of rescue analgesic. In our series, only one patient needed opioids during the first two postoperative days, and no rescue analgesic administration was noted in the remaining cases. Conclusion We report a small but promising experience regarding postoperative pain management with continuous ESPB performed after RATS. We implemented the ESPB before surgery. Larger studies on postoperative pain management with continuous regional blocks in thoracic surgery are warranted.
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Affiliation(s)
- Marco Cavaleri
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Stefano Tigano
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Roberta Nicoletti
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Valeria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Alberto Terminella
- Thoracic Surgery Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital "G. Rodolico" - San Marco Hospital, Catania, 95121, Italy
| | - Giacomo Cusumano
- Thoracic Surgery Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital "G. Rodolico" - San Marco Hospital, Catania, 95121, Italy
| | - Filippo Sanfilippo
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Marinella Astuto
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
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Lomangino I, Berni A, Lloret Madrid A, Terzi S, Melan L, Cannone G, Rebusso A, Zuin A, Dell'Amore A, Rea F. Sublingual sufentanil in pain management after pulmonary resection: a randomized prospective study. Ann Thorac Surg 2021; 113:1867-1872. [PMID: 34331930 DOI: 10.1016/j.athoracsur.2021.06.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/20/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful postoperative pain management after major lung resection surgery is mostly achieved through intravenous administration of analgesic drugs. This study explored the use of sublingual sufentanil cartridges (Zalviso) as a noninvasive alternative to post-operative analgesia. METHODS From July 2019 to April 2020, patients who underwent major thoracoscopic lung resection surgery were randomly allocated to receive either intravenous pain management, or patient controlled analgesia via the Zalviso system. Pain assessment scores were collected for a 72-h time window, and requests for additional medication due to insufficient pain control were recorded. RESULTS Of the 80 patients enlisted, 40 were assigned to the Zalviso group and 40 to the control group. The groups were not statistically different from each other. The difference in the mean pain scores reported was statistically significant in the first 24-h in favor of the Zalviso group (p=0.046) and the need of additional pain medication was significantly higher in the control group (p=0.004). CONCLUSIONS Patient controlled analgesia using sublingual sufentanil cartridges can provide an effective pain relief in patients undergoing video-assisted thoracic surgery and reduce the need for additional medication, offering a noninvasive alternative to traditional intravenous therapy.
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Affiliation(s)
- Ivan Lomangino
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy.
| | - Alessandro Berni
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Andrea Lloret Madrid
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Stefano Terzi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Luca Melan
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Alessandro Rebusso
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2 35121 Padova, Italy
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Lo T, Schiller R, Raghunathan K, Krishnamoorthy V, Jawitz OK, Pyati S, Van De Ven T, Bartz RR, Thompson A, Ohnuma T. Changes in analgesic strategies for lobectomy from 2009 to 2018. JTCVS OPEN 2021; 6:224-236. [PMID: 36003558 PMCID: PMC9390760 DOI: 10.1016/j.xjon.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 10/27/2022]
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Hodges JD, Nguyen DT, Doan J, Meisenbach LM, Chihara R, Chan EY, Graviss EA, Kim MP. Factors associated with home opioid use after thoracic surgery. JTCVS OPEN 2021; 5:173-186. [PMID: 36425360 PMCID: PMC9680902 DOI: 10.1016/j.xjon.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Enhanced recovery after surgery (ERAS) with a pre-emptive pain management program has been shown to decrease opioid prescriptions after thoracic surgery. We sought to determine which patient or procedural factors were associated with the need for prescription opioid medications after thoracic surgical procedures. METHODS We performed a retrospective analysis of a postoperative pain survey at the time of follow-up in combination with procedural and patient characteristic data. We then performed univariate and multivariate logistic regression to determine factors associated with prescription opioids use. RESULTS Two hundred twenty-eight patients completed questionnaires at a median of 37 days after surgery. Most patients received minimally invasive surgery (n = 213, 93%) with the 2 most common types of operations being foregut (n = 92, 40%) and pulmonary resection (n = 80, 35%). Thirty-nine percent of patients (n = 89) were taking chronic pain medications preoperatively, with 15% on chronic opioids medication (n = 33). After surgery, 166 patients (72%) did not take opioids at home. Multivariate analysis showed any chronic opioid medications before surgery (odds ratio, 28.8; 95% confidence interval, 9.13-90.8, P < .001) were associated with opioid use postoperatively. In contrast, increase in age was associated with a decrease in opioid use (odds ratio, 0.96; 95% confidence interval, 0.93-0.99, P = .01). CONCLUSIONS ERAS with pre-emptive pain management was associated with patients avoiding opioid prescriptions during recovery. The patient factor of preoperative opioid pain medication(s) and younger age is a significant factor for the patient needing opioids at home after surgery instead of procedural factors. Patient characteristics should be considered when tailoring the patient's pain management after thoracic surgical procedures.
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Affiliation(s)
- Jeffrey D. Hodges
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Tex
| | - Jane Doan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
| | - Leonora M. Meisenbach
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
| | - Ray Chihara
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
- Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex
| | - Edward Y. Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
- Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Tex
| | - Min P. Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
- Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex
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Ponholzer F, Ng C, Maier H, Dejaco H, Schlager A, Lucciarini P, Öfner D, Augustin F. Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption. J Clin Med 2021; 10:jcm10020372. [PMID: 33478098 PMCID: PMC7835787 DOI: 10.3390/jcm10020372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) affects patients’ recovery, postoperative complications, and length of stay (LOS). Despite its relevance, there are no guidelines on optimal perioperative pain management. This study aims to analyse the effects of an additional intercostal catheter (ICC) in comparison to a single shot intraoperative intercostal nerve block (SSINB). Methods: All patients receiving an anatomic VATS resection between June 2019 and May 2020 were analysed retrospectively. The ICC cohort included 51 patients, the SSINB cohort included 44 patients. Results: There was no difference in age, gender, comorbidities, or duration of surgery between cohorts. Pain scores on the first postoperative day, after chest drain removal, and highest pain score measured did not differ between groups. The overall amount of opioids (morphine equivalent: 3.034 mg vs. 7.727 mg; p = 0.002) as well as the duration of opioid usage (0.59 days vs. 1.25 days; p = 0.005) was significantly less in the ICC cohort. There was no difference in chest drain duration, postoperative complications, and postoperative LOS. Conclusions: Pain management with ICC reduces the amount of opioids and number of days with opioids patients require to achieve sufficient analgesia. In conclusion, ICC is an effective regional anaesthesia tool in postoperative pain management in minimally invasive thoracic surgery.
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Affiliation(s)
- Florian Ponholzer
- Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (C.N.); (H.M.); (P.L.); (D.Ö.)
| | - Caecilia Ng
- Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (C.N.); (H.M.); (P.L.); (D.Ö.)
| | - Herbert Maier
- Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (C.N.); (H.M.); (P.L.); (D.Ö.)
| | - Hannes Dejaco
- Department of Anaesthesiology and Critical Care, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.D.); (A.S.)
| | - Andreas Schlager
- Department of Anaesthesiology and Critical Care, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.D.); (A.S.)
| | - Paolo Lucciarini
- Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (C.N.); (H.M.); (P.L.); (D.Ö.)
| | - Dietmar Öfner
- Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (C.N.); (H.M.); (P.L.); (D.Ö.)
| | - Florian Augustin
- Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (C.N.); (H.M.); (P.L.); (D.Ö.)
- Correspondence: ; Tel.: +43-512-504-22601
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Devine G, Cheng M, Martinez G, Patvardhan C, Aresu G, Peryt A, Coonar AS, Roscoe A. Opioid-Free Anesthesia for Lung Cancer Resection: A Case-Control Study. J Cardiothorac Vasc Anesth 2020; 34:3036-3040. [DOI: 10.1053/j.jvca.2020.05.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/05/2023]
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Hegazy MA, Awad G, Abdellatif A, Saleh ME, Sanad M. Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy. Asian Cardiovasc Thorac Ann 2020; 29:98-104. [PMID: 33019807 DOI: 10.1177/0218492320965015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Paravertebral block can be performed with the aid of surgical landmarks, ultrasound, or a thoracoscope. This study was designed to compare ultrasound-guided paravertebral block with the thoracoscopic technique. METHODS This prospective randomized comparative study included 40 adults scheduled for elective thoracic surgery. Study participants were randomized to an ultrasound group or a thoracoscope group. A catheter for paravertebral block was inserted prior to thoracotomy with real-time ultrasound visualization in the ultrasound group, and under thoracoscopic guidance in the thoracoscope group. Total analgesic consumption, visual analogue pain score, technical difficulties, and complications were compared between the 2 groups. RESULTS Total analgesic consumption in the first 24 hours was less in the ultrasound group than in the thoracoscope group (rescue intravenous fentanyl 121.25 ± 64.01 µg in the ultrasound group vs. 178.75 ± 91.36 µg in the thoracoscope group; p = 0.027). Total paravertebral bupivacaine consumption was 376.00 ± 33.779 mg in the ultrasound group and 471.50 ± 64.341 mg in the thoracoscope group (p < 0.001). Technical difficulties and complications in terms of time consumed during the maneuver, more than one needle pass, and pleural puncture were significantly lower in the ultrasound group than in the thoracoscope group. CONCLUSION Ultrasound-guided paravertebral catheter insertion is more effective, technically easier, and safer than the thoracoscope-assisted technique.
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Affiliation(s)
- Mohammed A Hegazy
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Gehad Awad
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Amr Abdellatif
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
| | | | - Mohammed Sanad
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
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Mijovski G, Podbregar M, Kšela J, Jenko M, Šoštarič M. Effectiveness of wound infusion of 0.2% ropivacaine by patient control analgesia pump after minithoracotomy aortic valve replacement: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2020; 20:172. [PMID: 32682395 PMCID: PMC7368743 DOI: 10.1186/s12871-020-01093-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Local anesthetic wound infusion has become an invaluable technique in multimodal analgesia. The effectiveness of wound infusion of 0.2% ropivacaine delivered by patient controlled analgesia (PCA) pump has not been evaluated in minimally invasive cardiac surgery. We tested the hypothesis that 0.2% ropivacaine wound infusion by PCA pump reduces the cumulative dose of opioid needed in the first 48 h after minithoracothomy aortic valve replacement (AVR). METHODS In this prospective, randomized, double-blind, placebo-controlled study, 70 adult patients (31 female and 39 male) were analyzed. Patients were randomized to receive 0.2% ropivacaine or 0.9% saline wound infusion by PCA pump for 48 h postoperatively. PCA pump was programmed at 5 ml h- 1 continuously and 5 ml of bolus with 60 min lockout. Pain levels were assessed and recorded hourly by Numeric Rating Scale (NRS). If NRS score was higher than three the patient was administered 3 mg of opioid piritramide repeated and titrated as needed until pain relief was achieved. The primary outcome was the cumulative dose of the opioid piritramide in the first 48 h after surgery. Secondary outcomes were frequency of NRS scores higher than three, patient's satisfaction with pain relief, hospital length of stay, side effects related to the local anesthetic and complications related to the wound catheter. RESULTS The cumulative dose of the opioid piritramide in the first 48 h after minithoracotomy AVR was significantly lower (p < 0.001) in the ropivacaine (R) group median 3 mg (IQR 6 mg) vs. 9 mg (IQR 9 mg). The number of episodes of pain where NRS score was greater than three median 2 (IQR 2), vs 3 (IQR 3), (p = 0.002) in the first 48 h after surgery were significantly lower in the ropivacaine group, compared to control. Patient satisfaction with pain relief in our study was high. There were no wound infections and no side-effects from the local anesthetic. CONCLUSIONS Wound infusion of local anesthetic by PCA pump significantly reduced opioid dose needed and improves pain control postoperatively. We have also shown that it is a feasible method of analgesia and it should be considered in the multimodal pain control strategy following minimally invasive cardiac surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT03079830 , date of registration: March 15, 2017. Retrospecitvely registered.
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Affiliation(s)
- Gordan Mijovski
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
| | - Matej Podbregar
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Juš Kšela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Jenko
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Maja Šoštarič
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
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Patients with left ventricle assist devices presenting for thoracic surgery and lung resection: tips, tricks and evidence. Curr Opin Anaesthesiol 2020; 33:17-26. [PMID: 31815821 DOI: 10.1097/aco.0000000000000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Over a thousand left ventricular-assist device (LVAD) implants were performed for heart failure destination therapy in 2017. With increasing survival, we are seeing increasing numbers of patients present for noncardiac surgery, including resections for cancer. This article will review the relevant literature and guidelines for patients with LVADs undergoing thoracic surgery, including lung resection. RECENT FINDINGS The International Society for Heart and Lung Transplant Mechanically Assisted Circulatory Support Registry has received data on more than 16 000 patients with LVADs. Four-year survival is more than 60% for centrifugal devices. There are increasing case reports, summaries and recommendations for patients with LVADs undergoing noncardiac surgery. However, data on thoracic surgery is restricted to case reports. SUMMARY Successful thoracic surgery requires understanding of the LVAD physiology. Modern devices are preload dependent and afterload sensitive. The effects of one-lung ventilation, including hypoxia and hypercapnia, may increase pulmonary vascular resistance and impair the right ventricle. Successful surgery necessitates a multidisciplinary approach, including thorough preoperative assessment; optimization and planning of intraoperative management strategies; and approaches to anticoagulation, right ventricular failure and LVAD flow optimization. This article discusses recent evidence on these topics.
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Thompson-Brazill KA. Pain Control in the Cardiothoracic Surgery Patient. Crit Care Nurs Clin North Am 2019; 31:389-405. [DOI: 10.1016/j.cnc.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perioperative anesthetic management of patients with malignant pleural mesothelioma undergoing cytoreductive surgery and intraoperative chemotherapy. ACTA ACUST UNITED AC 2019; 67:15-19. [PMID: 31353039 DOI: 10.1016/j.redar.2019.03.003] [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: 01/08/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraoperative chemotherapy (HITHOC) is a therapeutic option for treatment of malignant pleural mesothelioma. Anesthetic management might be challenging. PATIENTS AND METHODS A descriptive analysis of a case series is presented. Seven patients with malignant pleural mesothelioma diagnostic undergoing HITHOC surgery were studied. Combined general and epidural anesthesia were administered. An intensive hemodynamic monitorization was implemented. Data regarding perioperative course was analyzed. RESULTS Between May 2015 and October 2018 7patients underwent HITHOC procedure. Blood transfusions were administered in all patients, and 5of the 7patients required vasoactive drug administration. Extubation at the end of the procedure was able in 6of the 7patients. The median length of stay in ICU was 4 days, and 29 days for the whole hospitalary stay. No significant postoperative pain was observed. CONCLUSIONS HITHOC surgery is a complex procedure in which several hemodynamic changes occur. An intensive intraoperative monitorization was useful for controlling complications.
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Fabio C, Giuseppe P, Chiara P, Antongiulio V, Enrico DS, Filippo R, Federica B, Eugenio AF. Sufentanil sublingual tablet system (Zalviso ®) as an effective analgesic option after thoracic surgery: An observational study. Saudi J Anaesth 2019; 13:222-226. [PMID: 31333367 PMCID: PMC6625280 DOI: 10.4103/sja.sja_109_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Sufentanil sublingual tablet system (SSTS) (Zalviso®) is a sublingual system for patient controlled analgesia, demonstrated to be an effective strategy for pain control after major abdominal and orthopedic surgery. We present a prospective observational study on the use of SSTS for the management of postoperative pain after thoracic surgery. The aim of this study was to assess the efficacy of Zalviso® in reducing pain scores and increasing respiratory ability during postoperative period. Materials and Methods There were about 40 patients underwent video assisted thoracoscopy were included in the study. All the enrolled patients signed the informed consent were educated to the use of the device. Pain numeric rating scale values (NRS) were recorded at awakening from anesthesia (T0) and during the next hours, both at rest and with cough. We evaluate the time to obtain a mean NRS value ≤3 and difference in pain scores between first and subsequent measurements as the primary outcomes. The ability to use incentive spirometer and eventual drug adverse effect were evaluated as secondary outcomes. Results All patients in recovery room experienced moderate to severe pain. Pain score at rest and coughing decreased to a mean NRS value ≤3 (mild pain) respectively after 2 and 6 hours and the pain score difference continued to increase significantly after repeated measurements. 67.5% of patients resumed the original spirometric ability in pod 1; 9.5% in pod 2; 12% in pod 3. Only three patients out of forty (7,5%) experienced nausea; one patient (2,5%) had a vomiting episode. Conclusion Our study showed SSTS as an effective option for postoperative pain management in thoracic surgery, improving pain scores and respiratory ability.
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Affiliation(s)
- Costa Fabio
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Pascarella Giuseppe
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Piliego Chiara
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Valenzano Antongiulio
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Di Sabatino Enrico
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Riccone Filippo
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Bruno Federica
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
| | - Agro' F Eugenio
- Unit of Anesthesia and Intensive Care, Policlinico Universitario Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy
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