Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

Abstract

BackgroundWe compared the effects of thoracic epidural analgesia (TEA) to conventional patient‐controlled analgesia (PCA) on several postoperative parameters of recovery after elective video‐assisted thoracoscopic (VATS) lobectomy.MethodsNinety‐eight patients undergoing elective VATS lobectomy were enrolled. The primary endpoint was pain score. Recovery of bowel function, length of stay in the postanesthesia care unit (PACU), duration of postoperative hospital stay, and complications were assessed. Continuous variables were expressed and compared between groups using either a two‐tailed Student's t or Mann‐Whitney U test. Recovery of bowel function was compared using the log‐rank test.ResultsBaseline characteristics between the groups were similar. Dynamic pain scores on postoperative days (PODs) 0–2 were significantly lower in the TEA group, as were resting pain scores on PODs 1 and 2 (P < 0.05). The mean duration to first flatus (16 ± 0.7 vs. 26 ± 0.7 hours; P < 0.001) and the mean length of stay in the PACU (34 vs. 67 minutes; P = 0.027) were shorter in the TEA compared to the PCA group, respectively. The only difference in postoperative complications was regarding confusion (5 TEA vs. 18 PCA patients; P = 0.002). No difference in overall length of stay was noted.ConclusionsCompared to PCA, TEA provided better postoperative pain control after VATS lobectomy and facilitated postoperative recovery of bowel function without increasing the length of hospital stay. This beneficial effect of TEA might be attributed to the attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.

Continuous Paravertebral Analgesia versus Continuous Epidural Analgesia after Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial

“…These results were consistent with other studies. 26) However, there was no difference in the incidence of complications between the two groups at 48 hours after operation. Although the incidence of complications in TEA group was higher, the overall satisfaction of patients was higher in TEA group, which might be related to the better analgesic effect of TEA.…”

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

“…El-Tahan [15] emphasized that t-PCEA usage could be associated with favorable postoperative pulmonary function, a low incidence of postoperative pulmonary complications, fast return of normal bowel function, and a shorter hospital stay after thoracic surgery. Zejun et al [14] also conducted a prospective randomized study, which showed that when compared with IVPCA, t-PCEA resulted in not only lower postoperative pain scores, but also earlier restoration of bowel function after VATS lobectomy. Tiippana et al [6] agreed that t-PCEA with local anesthetics and opioids was superior to IVPCA with opioids for post-thoracotomy pain and the recovery of pulmonary function.…”

“…[2,19,23] Morphine has a good antinociceptive effect, but is associated with some well-known adverse effects, including respiratory depression, excessive sedation, nausea, vomiting, ileus, and constipation, [2,5,19–21] all of which preclude its continuous use. Despite the use of different components in IVPCA, such as oxycodone or sufentanil rather than fentanyl, some studies [2,14] still showed that t-PCEA provided superior analgesia and less opioid-related complications compared to IVPCA in thoracic surgeries. In our hospital, fentanyl is routinely used in IVPCA for postoperative pain control in all kinds of surgeries, as it has a quicker onset and results in less sedation than morphine.…”

“…Current analgesic options for acute post-thoracotomy pain include thoracic patient-controlled epidural analgesia (t-PCEA), intravenous patient-controlled analgesia (IVPCA), thoracic paravertebral block, and continuous paravertebral infusion with local anesthetics. [5] Though continuous t-PCEA remains the gold standard for treating acute pain after open thoracic surgery, [1–4,6,7,12,14,15] thoracic epidural catheterization is an invasive procedure that may cause pain and takes time to perform. [1] The technique can lead to devastating complications, such as neurological deficits [1,12,16] or epidural hematoma, [1,4,6,12,16,17] and cannot be used with anticoagulated patients or those with severe spinal deformities.…”

The Effect of Oblique Lumbar Interbody Fusion Compared with Transforaminal Lumbar Interbody Fusion Combined with Enhanced Recovery after Surgery Program on Patients with Lumbar Degenerative Disease at Short-Term Follow-Up

“…Enhanced recovery after surgery (ERAS) programs have become increasingly popular in different fields of surgery over the past decade [ 11 ]. The concept of ERAS was originally put forward in the field of general surgery and colonic resection [ 12 ].…”