Lung Function After Lobectomy: A Randomized, Double-Blinded Trial Comparing Thoracic Epidural Ropivacaine/Sufentanil and Intravenous Morphine for Patient-Controlled Analgesia

Bauer, Christian; Hentz, J. G.; Ducrocq, Xavier; Meyer, Nicolas; Oswald‐Mammosser, Monique; Steib, A.; Dupeyron, J. P.

doi:10.1213/01.ane.0000266441.58308.42

Cited by 68 publications

(29 citation statements)

References 23 publications

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“…TEA in patients after lobectomy resulted in better pain relief and pulmonary function compared with IV morphine (Bauer et al, 2007 Level II). When started preoperatively in comparison to postoperatively, TEA reduced the severity of acute postthoracotomy pain, but not the incidence of chronic pain (Bong et al, 2005 Level I).…”

Section: Chaptermentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Chaptermentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…However, suspicion of bronchial stump leakage should be triggered by fl orid subcutaneous emphysema. Although not proven conclusively, adequate pain control after thoracotomy pneumonectomy may reduce the incidence of complications (Ballantyne et al 1998 ;Bauer et al 2007 ;De Cosmo et al 2009 ;Hazelrigg et al 2002 ;Liu and Wu 2007 ).…”

Section: Resultsmentioning

confidence: 99%

Thoracotomy Pneumonectomy

Dexter

Demmy

2014

Chest Surgery

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“…to achieve a rapid improvement in pulmonary function. According to the principles of ERAS, analgesic drugs such as opioids are preferably avoided and analgesia with ropivacaine and sufentanil via thoracic epidural anesthesia (TEA) is preferred over intravenous morphine administration, resulting in a significant improvement of pulmonary function after lung surgery (63). Patients with epidural pain control showed a faster improvement in lung volumes, reducing the incidence of pulmonary complications such as atelectasis and pneumonia.…”

Section: Postoperative Rehabilitationmentioning

confidence: 99%

A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy

Bertani¹,

Ferrari²,

Terzo³

et al. 2018

J. Thorac. Dis.

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Background: Video-assisted thoracoscopic surgery (VATS) lobectomy has recently been adopted as the gold standard surgical option for the treatment of early stage non-small cell lung cancer. Enhanced recovery after surgery (ERAS) is being progressively adopted in thoracic surgery to improve the postoperative outcomes. Even if the benefits of ERAS are universally accepted, to date a standardized and uniform approach has not been described in the medical literature. The Italian VATS group has recently proposed to include in the VATS lobectomy database a structured protocol for ERAS. Methods:The ERAS section of the Italian VATS group is proposing a comprehensive ERAS protocol within the VATS lobectomy database, allowing the prospective collection of a dedicated set of data. Separate sections of the protocol are dedicated to different topics of ERAS. This study is specifically dedicated to the section of physiokinesis therapy. The medical literature will be extensively reviewed and a physiotherapy (PT) protocol of ERAS will be presented and discussed. A seta of structured clinical pathways will also be suggested for adoption in the VATS Group database.Discussion: Pre-and post-operative adoption of an ERAS protocol in patients undergoing VATS lobectomy may promote an improved post-operative course, a shorter hospital stay and an overall more comfortable patients' experience. The mainstays of a physiokinesis therapy ERAS protocol are patients' education, constant physical and respiratory therapy sessions, and adoption of adequate devices. Although many studies have investigated the usefulness of physical and respiratory physiokinesis therapy, a comprehensive ERAS protocol for VATS lobectomy patients has not yet been described. The proposed ERAS platform, adopted by the VATS Group database, will contribute to a prospective data collection and allow a scientific analysis of the results.

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Lung Function After Lobectomy: A Randomized, Double-Blinded Trial Comparing Thoracic Epidural Ropivacaine/Sufentanil and Intravenous Morphine for Patient-Controlled Analgesia

Abstract: After lobectomy, TEA enables a significant increase in pulmonary function concomitant with better pain relief than systemic morphine, although a modest intercostal motor block may occur.

Cited by 68 publications

References 23 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Thoracotomy Pneumonectomy

A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy

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