Is Epidural Analgesia Necessary after Video-Assisted Thoracoscopic Lobectomy?

Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Igarashi, Takashi; Abe, Jun; Shimizu, Kimihiro; Takeyoshi, Isumi

doi:10.1177/0218492310381817

Cited by 40 publications

(35 citation statements)

References 16 publications

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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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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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“…The surgical procedures were performed by three authors (MK, TN, and HI). The VATS technique has been described in detail elsewhere . Although it continues to be performed essentially as published, several minor modifications were made.…”

Section: Methodsmentioning

confidence: 99%

Unanticipated troubles in video‐assisted thoracic surgery: A proposal for the classification of troubleshooting

Kamiyoshihara

Nagashima

Igai

et al. 2011

Asian J Endoscop Surgery

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“…In the transition from thoracotomy to VATS lobectomy, many centres continued using the same protocol for the management of intra-and post-operative pain: TEA used to be the analgesic gold standard for open thoracic surgery, but it is clear that the use of TEA minimizes the benefits of a technique associated with less post-operative pain (15)(16)(17)(18)(19).…”

Section: Vats Lobectomy Was First Described As a Surgical Treatmentmentioning

confidence: 99%

VATS lobectomy: does surgical heterogeneity prevent evidence on pain control?

Santambrogio¹,

Musso²

2018

J. Thorac. Dis.

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Is Epidural Analgesia Necessary after Video-Assisted Thoracoscopic Lobectomy?

Cited by 40 publications

References 16 publications

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

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

Unanticipated troubles in video‐assisted thoracic surgery: A proposal for the classification of troubleshooting

VATS lobectomy: does surgical heterogeneity prevent evidence on pain control?

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