Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery

Tseng, Wei‐Cheng; Lin, Weilin; Lai, Hou-Chuan; Huang, Tsai-Wang; Chen, Pin-Hsuan

doi:10.1097/md.0000000000016403

Cited by 27 publications

(23 citation statements)

References 25 publications

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“…Tseng et al (16) emphasized the results of our study as they examined a combination of fentanyl and low-dose ketamine as patient-controlled analgesia (PCA) versus epidural PCA in 70 patients after video-assisted thoracic surgery.…”

Section: Discussionmentioning

confidence: 92%

“…Ketamine has been tested in many studies to examine its analgesic effect either preoperatively or intraoperatively (9)(10)(11)(12)(13)(14)(15)(16)(17). Minoshima et al (14) examined a low dose of ketamine infusion 48 h intra-and postoperatively versus the placebo in 36 patients subjected to scoliosis corrective surgery and found that Ketamine infusion reduced morphine consumption significantly over the next 48 h.…”

Section: Discussionmentioning

confidence: 99%

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Low-Dose Ketamine Infusion Versus Morphine Infusion During Abdominoplasty to Change the Postoperative Pain Profile

2020

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Background: With the increased number of abdominoplasty all over the world, and the need to manage postoperative pain, it is a must to find proper and effective drugs to decrease opioid consumption in the postoperative period. Objectives: In this double-blind randomized controlled clinical trial, we assumed that low-dose ketamine infusion will reduce the postoperative pain profile than the conventional method of morphine. Methods: The scheduled patients for abdominoplasty under general anesthesia were recruited in two groups: group (K) with low-dose ketamine infusion intra-operatively (80 patients) and group (M) with morphine infusion intra-operatively (80 patients). Both groups were monitored intraoperatively and postoperatively for rescue doses of fentanyl, visual analogue scale (VAS), and side effects. Results: There were no statistical differences between both groups regarding the fentanyl rescue doses intra- and postoperative with no remarkable side effects. Conclusions: Low-dose ketamine has a useful analgesic effect in abdominoplasty similar to morphine without remarkable side effects, such as sedation or hallucinations.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Low-Dose Ketamine Infusion Versus Morphine Infusion During Abdominoplasty to Change the Postoperative Pain Profile

2020

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“…Efficacy of epidural has been validated in previously published smaller series. [ 6 , 7 , 13 , 14 ] Further studies addressing newer analgesic techniques like paravertebral blocks, serratus anterior block, and erector spinal plane block would be needed to scientifically address optimal pain control in patients undergoing lung transplantation via T.…”

Section: Discussionmentioning

confidence: 99%

Impact of surgical technique and analgesia on clinical outcomes after lung transplantation

et al. 2020

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There is paucity of data on the impact of surgical incision and analgesia on relevant outcomes. A retrospective STROBE-compliant cohort study was performed between July 2007 and August 2017 of patients undergoing lung transplantation. Gender, age, indication for lung transplantation, and the 3 types of surgical access (Thoracotomy (T), Sternotomy (S), and Clamshell (C)) were used, as well as 2 analgesic techniques: epidural and intravenous opioids. Outcome variables were: pain scores; postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation, and length of stay at intensive care unit (ICU). Three hundred forty-one patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01; 2.74, P : .045) and no differences were found between Clamshell and Sternotomy incision. The median blood loss was 800 mL [interquartile range (IQR): 500; 1238], thoracotomy patients had 500 mL [325; 818] ( P < .001). Median durations of mechanical ventilation in Thoracotomy, Sternotomy, and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours, and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU ( P < .001). Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation, and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.

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“…In our previous study, opioid-based IV-PCA with an adjunct could provide sufficient pain relief, similar to thoracic epidural analgesia, after video-assisted thoracic surgery, leading to moderate-to-severe postoperative pain. 11 Hausken et al 17 20 demonstrated that intraoperative DEX infusion could decrease bleeding and provide a better surgical field, because of more stable hemodynamics. In addition, a meta-analysis showed that systemic administration of DEX could significantly decrease intraoperative blood loss in nasal surgery.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive dexmedetomidine infusion in open living donor hepatectomy: A way to enhance postoperative analgesia and recovery

Tseng

Lin

Lai

et al. 2021

Int. J. Clin. Pract.

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Open living donor hepatectomy (OLDH) is an intensely painful procedure, with moderate-to-severe pain during the first 2 days after surgery; furthermore, 31% and 27% of donors have developed persistent pain by 6 and 12 months after OLDH, respectively. 1 Inadequate control of perioperative pain will affect the overall quality of life and may contribute to chronic pain. Therefore, advanced strategies should be used to enhance perioperative analgesia and postoperative recovery in patients undergoing OLDH.Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary, and multimodal approach to patient care during the perioperative period. The ERAS pathways seek to blunt surgical stress and maintain endocrine and metabolic homeostasis, thereby

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Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery

Abstract: Supplemental Digital Content is available in the text

Cited by 27 publications

References 25 publications

Low-Dose Ketamine Infusion Versus Morphine Infusion During Abdominoplasty to Change the Postoperative Pain Profile

Low-Dose Ketamine Infusion Versus Morphine Infusion During Abdominoplasty to Change the Postoperative Pain Profile

Impact of surgical technique and analgesia on clinical outcomes after lung transplantation

Adjunctive dexmedetomidine infusion in open living donor hepatectomy: A way to enhance postoperative analgesia and recovery

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