The efficacy of the ON-Q elastomeric pump system in post-thoracotomy acute pain control

Objectives

We aimed to evaluate the efficacy of continuous local anesthetic infusion to the incision site with the On-Q elastomeric pump system in postoperative acute pain control after thoracotomy.

Methods

A retrospective comparative analysis of of sixty patients who underwent thoracotomy for lung cancer by the same surgical team was performed between January 2016 and December 2017. The patients were divided into two groups according to postoperative pain management, those who were traditionally received tramadolol (15 mg/h) by intravenous continuous infusion (Group IVT, n = 30) and those who were administered continuous local anesthetic (0.5% bupivacaine, 4 ml/h) infusion to the incision site through an elastomeric pump in addition to the traditional treatment (Group LA, n = 30). The primary outcomes were postoperative acute pain scores on the numeric rating scale and postoperative rescue opioid consumption for 72 hours following surgery reported as pethidine equivalents. The secondary outcomes were frequency of analgesia related adverse events/complications, ICU and hospital stay, drug and total hospital cost.

Results

The mean pain scores at 2, 12, 24, 48 and 72^th hours at rest and during coughing were found to be significantly lower in group LA (p < 0.05). Rescue opioid consumption on postoperative 0, 1, 2 and 3^rd days and in total was found to be significantly lower in Group LA (p < 0.05). In Group LA, postoperative length of hospital stay was significantly shorter (5.8 ± 2.1 days vs. 8.0 ± 3.1 days; p = 0.034), drug costs (95.24 vs. 160.08 Euro; p = 0.023) and total hospital costs were lower (434.26 vs. 685.75 Euro; p = 0.014) than Group IVT.

Conclusions

We believe that continuous local anesthetic infusion to the incision site in addition to systemic analgesic treatment for multimodal acute pain management after thoracotomy is an effective and safe method.

Benign posterior mediastinal neurogenic tumors: results of a comparative study into video-assisted thoracic surgery and thoracotomy (13 years' experience)

OBJECTIVE

Mediastinal neurogenic tumors originate from the nerve tissues of the thorax and are generally located in the posterior mediastinum. The present study was performed to compare the results of thoracotomy with those of video-assisted thoracic surgery (VATS) for the surgical treatment of posterior mediastinal neurogenic tumors.

METHODS

Twenty patients who underwent surgical resection for posterior neurogenic tumors between January 1996 and January 2009 were examined retrospectively. Thirteen (65%) patients were treated by thoracotomy (group T) and VATS was used in seven (35%) patients (group V).

RESULTS

The duration of surgery was shorter in group V (83.5 ± 19 min) than in group T (124.6 ± 16.6 min; P < 0.0001). Chest drains were withdrawn earlier in group V (after 1 day) than in group T (1.6 ± 0.5 days; P = 0.005). The hospital stay was shorter for group V (1 day) compared with group T (3 ± 0.9 days; P < 0.0001) and group V required fewer analgesics than group T (P < 0.0001).

CONCLUSION

VATS is the preferred treatment for posterior neurogenic tumors that show no preoperative signs of malignancy and do not involve the medulla spinalis.