Epidural opioids for post-thoracotomy pain

Grant, Raymer P.

doi:10.1007/bf03009826

Cited by 6 publications

(3 citation statements)

References 30 publications

(22 reference statements)

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“…108 Of importance, various investigators have suspected a possible increase in longer-term neuropathic-like pain in patients who had intraoperative cryoneurolysis under direct vision, 25,42,44,50,60 although the limitations of these observations have been noted. 126 Indeed, two subsequent randomized, controlled trials did find a clinically relevant and statistically significant increased incidence of neuropathic pain 3 to 6 months after open thoracotomy with surgically applied cryoneurolysis. 40,43 However, the majority of randomized, controlled trials have not reported similar findings, and this discrepancy remains unresolved.…”

Section: Contraindications and Complicationsmentioning

confidence: 99%

“…However, when viewed in light of the preclinical data, it appears somewhat unsurprising that some healthcare providers report a high incidence of neuralgias in their practice (highest 38%), 60 whereas others do not (largest neuralgia-free series: 0% in over 1,500 patients). 126 If intraoperative nerve manipulation is the cause of a possible increased incidence of neuropathic pain, then ultrasound-guided percutaneous cryoneurolysis should have no comparable risk. Indeed, to date, no incidence of neuropathic pain has been correlated with percutaneous administration.…”

Section: Contraindications and Complicationsmentioning

confidence: 99%

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Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Ilfeld¹,

Finneran²

2020

Anesthesiology

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Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.

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Section: Contraindications and Complicationsmentioning

confidence: 99%

Section: Contraindications and Complicationsmentioning

confidence: 99%

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Ilfeld¹,

Finneran²

2020

Anesthesiology

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“…10 Unfortunately, it is impossible to correlate technique and outcome because the majority of publications do not adequately describe the precise technique or degree of nerve manipulation. However, considering the previously unreported laboratory finding that nerve elevation was required to induce chronic pain-and treatment of the nerve in situ never resulted in chronic pain-it is perhaps unsurprising that the incidence of neuralgias after open surgical cryoneurolysis varies so dramatically from 0% (one series of greater than 1,500 patients) 11 to 38%. 12 If nerve manipulation is required for the postcryoneurolysis neuropathic pain reported in patients, then ultrasound-guided percutaneous cryoneurolysis-as used in the clinical trial addressed by the editorial 1 -should carry no comparable risk.…”

Section: Cryoneurolysis: Interest and Caution: Commentmentioning

confidence: 99%

Cryoneurolysis: Interest and Caution: Comment

Ilfeld

Wagner²

2023

Anesthesiology

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A comparison of thoracic and lumbar epidural techniques for post-thoracoabdominal esophagectomy analgesia

Kahn

Baxter

Dauphin

et al. 1999

Can J Anesth/J Can Anesth

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A comparison of thoracic and lumbar epidural techniques for postthoracoabdominal esophagectomy analgesiaPurpose: To compare thoracic epidural analgesia (TEA) using a bupivacaine/[entanyl mixture and lumbar epidural analgesia (LEA) with morphine, in respect to the time to extubation and the quality of post-operative analgesia, in patients having thoracoabdominal esophagectomy. Methods: Twenty two patients scheduled for elective thoracoal:x:lominal esophagectomy were randomized to TEA or LEA. Postoperatively, the TEA group received Patient Controlled Epidural Analgesia (PCEA) with bupivacaine 0.12596 and 5/./g'ml Bt fentanyl, and the LEA group received PCEA with 0.2/ag'ml Bl morphine. A blinded observer assessed criteria for tracheal extubation and the time of tracheal extubation was recorded. Early extubation was defined as tracheal extubation within four hours postoperatively. Visual analogue pain scores at rest (Static Visual Analogue Pain Scores, SVAPS) and with movement (Dynamic Visual Analogue Pain Scores, DVAPS) were recorded at I , 6, 12, 18 and 24 hr post-extubation. Failure of the epidural protocol (FEP) was defined as a request for additional analgesia. Results: Tracheal extubation was achieved in 70% of the LEA and 100~ of the TEA at four hours postoperatively (P=NS). However, the TEA group achieved earlier extubation times when assessed with log rank testing (P = 0.01 ). By six hours postextubation FEP had occurred in 50% of the LEA group but in none of the TEA group (P = 0.0 I). Mean SVAPS and DVAPS were lower in the TEA than in the LEA group at all measured times (P < 0.01).Conclusion: This study has demonstrated superior pain control in patients undergoing thoraco-abdominal esophagectomy treated with TEA than with LEA, particularly for pain with movement. Tracheal extubation occurred earlier in the TEA group, but this difference was not significant at four hours postoperatively.

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Epidural opioids for post-thoracotomy pain

Cited by 6 publications

References 30 publications

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Cryoneurolysis: Interest and Caution: Comment

A comparison of thoracic and lumbar epidural techniques for post-thoracoabdominal esophagectomy analgesia

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