Chest Tube–Delivered Bupivacaine Improves Pain and Decreases Opioid Use After Thoracoscopy

Demmy, Todd L.; Nwogu, Chukwumere; Solan, Patrick D.; Yendamuri, Saikrishna; Wilding, Gregory E.; DeLeon, Oscar

doi:10.1016/j.athoracsur.2008.12.099

Cited by 39 publications

(25 citation statements)

References 16 publications

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“…Analysis of the literature revealed only five randomised and two observational clinical trials concerning the lung resections of comparable extents that can be compared with our findings. Four of those mentioned above focused exclusively on lobectomy [9,10,16,17], and three dealt with mixed procedures (lobectomies, segmentectomies, and wedge resections) [6,11,18]. Continuous paravertebral block and continuous epidural anaesthesia have been compared in only one of the cited studies [6].…”

Section: Resultsmentioning

confidence: 99%

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Kosiński¹,

Fryzlewicz²,

Wilkojc³

et al. 2016

Anaesthesiol Intensive Ther

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Background: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. Methods: Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. Results: Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). Conclusions: Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.

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Section: Resultsmentioning

confidence: 99%

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Kosiński¹,

Fryzlewicz²,

Wilkojc³

et al. 2016

Anaesthesiol Intensive Ther

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“…Currently, no golden standard exists with regard to single port VATS postoperative pain management. Various kinds of postoperative analgesia have been tried by thoracic surgeons and anesthesiologists (9)(10)(11)(12)(13)(14)(15). Regional analgesia techniques seem to be effective in postoperative management.…”

Section: Discussionmentioning

confidence: 99%

Management of post-operative pain by placement of an intraoperative intercostal catheter after single port video-assisted thoracoscopic surgery: a propensity-score matched study

Wu¹,

Hsieh²,

Liu³

et al. 2016

J. Thorac. Dis.

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Background: The establishment of a golden standard for post-operative analgesia after thoracic surgery remains an unresolved issue. Benefiting from the rapid development of single port video-assisted thoracoscopic surgery (VATS), a good candidate for the alleviation of patients' pain is the placement of an intercostal catheter (ICC) safely after uniport VATS. We hypothesized that continual infusion through ICC could provide effective analgesia for patients with only one wound and we evaluate its postoperative analgesic function in uniport VATS patients with or without intercostal nerve blockade.Methods: Since March 2014, 235 patients received various kinds of single port VATS. We identified 50 patients who received single port VATS with intercostal nerve blockade and retrospectively compared them with a group of patients who had received single port VATS without intercostal nerve blockade. The operative time, post operation day 0, 1, 2, 3 and discharge day pain score, narcotic requirements, drainage duration and post-operative hospital stay were collected. In order to establish a well-balanced cohort study, we also used propensity scores matching (1:1) to compare the short term clinical outcome in two groups.Results: No operative deaths occurred in this study. The uniport VATS with intercostal nerve blockade group was associated with less post operation day 0 and day 1 pain score, and narcotic requirements in our cohort study (P<0.001, <0.001, and 0.003). After propensity scores matching, there were 50 patients in each group. Mean day 0 and day 1, day 2, day 3 pain score, drainage duration, post-operative hospital stay, and narcotic requirements were smaller in uniport VATS with intercostal nerve blockade (P<0.001, <0.001, 0.038, 0.007, 0.02, 0.042, and 0.003). Conclusions:In conclusion, in patients post single port VATS, continual intercostal nerve block with levobupivacaine infusion appears to be a safe, effective and promising technique in our study, associated with a shorter hospital stay and less post-operative pain. Further prospective trials are needed to determine the long term outcomes.

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“…Intrapleural block was used safely and successfully for pain management after VATS and thoracotomy, either as intermittent bolus doses or as continuous infusion [60–63]. It has been used in long-term pain management of cancer patients, chronic thoracotomy pain with intermittent injection [64–67], chronic abdominal or pancreatic pain [68–70], chest wall trauma, rib fractures [71], and even postoperative coronary artery bypass graft (CABG) [72–74].…”

Section: Treatmentsmentioning

confidence: 99%

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

Yousefshahi

Predescu

Colizza

et al. 2016

Pain Research and Management

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Context. Postthoracotomy Ipsilateral Shoulder Pain (IPS) is a common and sometimes intractable pain syndrome. IPS is different from chest wall pain in type, origin, and treatments. Various treatments are suggested or applied for it but none of them is regarded as popular accepted effective one. Objectives. To review data and collect all present experiences about postthoracotomy IPS and its management and suggest future research directions. Methods. Search in PubMed database and additional search for specific topics and review them to retrieve relevant articles as data source in a narrative review article. Results. Even in the presence of effective epidural analgesia, ISP is a common cause of severe postthoracotomy pain. The phrenic nerve has an important role in the physiopathology of postthoracotomy ISP. Different treatments have been applied or suggested. Controlling the afferent nociceptive signals conveyed by the phrenic nerve at various levels—from peripheral branches on the diaphragm to its entrance in the cervical spine—could be of therapeutic value. Despite potential concerns about safety, intrapleural or phrenic nerve blocks are tolerated well, at least in a selected group of patient. Conclusion. Further researches could be directed on selective sensory block and motor function preservation of the phrenic nerve. However, the safety and efficacy of temporary loss of phrenic nerve function and intrapleural local anesthetics should be assessed.

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Chest Tube–Delivered Bupivacaine Improves Pain and Decreases Opioid Use After Thoracoscopy

Cited by 39 publications

References 16 publications

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Management of post-operative pain by placement of an intraoperative intercostal catheter after single port video-assisted thoracoscopic surgery: a propensity-score matched study

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

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