A Novel Technique of Paravertebral Thoracic and Preperitoneal Analgesia Enhances Early Recovery After Oesophagectomy

Phillips, Stephanie; Dedic-Hagan, Jasmina; Baxter, d’Arcy Ferris; Wall, Hans Van der; Falk, Gregory L.

doi:10.1007/s00268-017-4369-9

Cited by 9 publications

(4 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The hypotensive effect of epidural anesthesia might require inotropic hemodynamic support at an ICU level of care. Paravertebral analgesia has enjoyed increasing interest in recent years since it may reduce the incidence of hypotensive events and therefore instigate shorter ICU stay [24,25]. Hospital logistics might also play a crucial role in the hospital variation found in the current study.…”

Section: Discussionmentioning

confidence: 81%

Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

Voeten

Werf

Gisbertz

et al. 2021

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Introduction: The value of routine intensive care unit (ICU) admission after minimally invasive esophagectomy (MIE) has been questioned. This study aimed to investigate Dutch hospital variation regarding length of direct postoperative ICU stay, and the impact of this hospital variation on short-term surgical outcomes. Materials and methods: Patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) undergoing curative MIE were included. Length of direct postoperative ICU stay was dichotomized around the national median into short ICU stay (1 day) and long ICU stay (> 1 day). A case-mix corrected funnel plot based on multivariable logistic regression analyses investigated hospital variation. The impact of this hospital variation on short-term surgical outcomes was investigated using multilevel multivariable logistic regression analyses. Results: Between 2017 and 2019, 2110 patients from 16 hospitals were included. Median length of postoperative ICU stay was 1 day [hospital variation: 0e4]. The percentage of short ICU stay ranged from 0 to 91% among hospitals. Corrected for case-mix, 7 hospitals had statistically significantly higher short ICU stay rates and 6 hospitals had lower rates. ICU readmission, in-hospital/30-day mortality, failure to rescue, postoperative pneumonia, cardiac complications and anastomotic leakage were not associated with hospital variation in length of ICU stay. Total length of hospital stay was significantly shorter in hospitals with relatively short ICU stay. Conclusion: This study showed significant hospital variation in postoperative length of ICU stay after MIE. Short ICU stay was associated with shorter overall hospital admission and did not negatively impact short-term surgical outcomes. More selected use of ICU resources could result in a national significant cost reduction.

show abstract

Section: Discussionmentioning

confidence: 81%

Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

Voeten

Werf

Gisbertz

et al. 2021

European Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…With latter techniques available such as paravertebral analgesia, one could argue what the best method may be in this patient population. Retrospective case series suggest that paravertebral analgesia is associated with less technical failure and reduced incidence of hypotensive events, both could promote postoperative recovery [ 40 , 41 ]. Based on these retrospective results, a prospective multicenter randomized controlled trial comparing paravertebral and epidural analgesia regarding perioperative outcomes and treatment costs in patients undergoing MIE is performed in the Netherlands with expected results by 2023 [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Pain management after robot-assisted minimally invasive esophagectomy

Rosner

Sluis

Meyer

et al. 2023

Heliyon

View full text Add to dashboard Cite

“…In absence of trials in patients undergoing MIE, both epidural and paravertebral analgesia were considered to be suitable options based on extrapolated evidence, although no recommendations in favour of either modality could be made [25]. Retrospective cases series suggest that paravertebral analgesia is associated with less technical failure and reduces the incidence of hypotensive events, which may promote postoperative recovery [26,27]. Combined with inconclusive ERAS recommendations regarding the use of either epidural or paravertebral analgesia, these retrospective findings represent an important rationale to perform a prospective randomized controlled trial comparing paravertebral and epidural analgesia regarding perioperative outcomes and treatment costs in patients undergoing MIE.…”

Section: Discussionmentioning

confidence: 99%

Paravertebral catheter versus EPidural analgesia in Minimally invasive Esophageal resectioN: a randomized controlled multicenter trial (PEPMEN trial)

et al. 2020

View full text Add to dashboard Cite

Background: Thoracic epidural analgesia is the standard postoperative pain management strategy in esophageal cancer surgery. However, paravertebral block analgesia may achieve comparable pain control while inducing less side effects, which may be beneficial for postoperative recovery. This study primarily aims to compare the postoperative quality of recovery between paravertebral catheter versus thoracic epidural analgesia in patients undergoing minimally invasive esophagectomy. Methods: This study represents a randomized controlled superiority trial. A total of 192 patients will be randomized in 4 Dutch high-volume centers for esophageal cancer surgery. Patients are eligible for inclusion if they are at least 18 years old, able to provide written informed consent and complete questionnaires in Dutch, scheduled to undergo minimally invasive esophagectomy with two-field lymphadenectomy and an intrathoracic anastomosis, and have no contra-indications to either epidural or paravertebral analgesia. The primary outcome is the quality of postoperative recovery, as measured by the Quality of Recovery-40 (QoR-40) questionnaire on the morning of postoperative day 3. Secondary outcomes include the QoR-40 questionnaire score Area Under the Curve on postoperative days 1-3, the integrated pain and systemic opioid score and patient satisfaction and pain experience according to the International Pain Outcomes (IPO) questionnaire, and cost-effectiveness. Furthermore, the groups will be compared regarding the need for additional rescue medication on postoperative days 0-3, technical failure of the pain treatment, duration of anesthesia, duration of surgery, total postoperative fluid administration day 0-3, postoperative vasopressor and inotrope use, length of urinary catheter use, length of hospital stay, postoperative complications, chronic pain at six months after surgery, and other adverse effects. Discussion: In this study, it is hypothesized that paravertebral analgesia achieves comparable pain control while causing less side-effects such as hypotension when compared to epidural analgesia, leading to shorter postoperative length of stay on a monitored ward and superior quality of recovery. If this hypothesis is confirmed, the results of this study can be used to update the relevant guidelines on postoperative pain management for patients undergoing minimally invasive esophagectomy.

show abstract

A Novel Technique of Paravertebral Thoracic and Preperitoneal Analgesia Enhances Early Recovery After Oesophagectomy

Abstract: The data demonstrated that it was possible to provide excellent post-oesophagectomy analgesia equivalent to thoracic epidural infusions of local anaesthetic with reduction in inotrope requirements, intensive care stay, more rapid mobilisation, facilitating enhanced recovery.

Cited by 9 publications

References 27 publications

Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

Pain management after robot-assisted minimally invasive esophagectomy

Paravertebral catheter versus EPidural analgesia in Minimally invasive Esophageal resectioN: a randomized controlled multicenter trial (PEPMEN trial)

Contact Info

Product

Resources

About