New developments in the treatment of acute pain after thoracic surgery

Maxwell, Cory; Nicoara, Alina

doi:10.1097/aco.0000000000000029

Cited by 45 publications

(45 citation statements)

References 34 publications

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“…Acetaminophen's metabolite appears to inhibit the reuptake of the endogenous cannabinoid by neurons, making it more available to reduce pain [17]. NSAIDs inhibit the COX enzyme preventing inflammation and prostaglandin synthesis [1]. In thoracic surgery, NSAIDs are particularly useful in reducing opioid consumption and treating referred pain to the ipsilateral shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…Taking advantage of the additive or synergistic effects of drug combinations on controlling pain can most effectively achieve the goal of reducing both pain scores and opioid consumption [1,5,8]. Gabapentin is usually used to treat neuropathic pain and its mechanism of action involves binding to the α 2 δ-1 and α 2 δ-2 auxiliary subunits of calcium channels in the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…However, pain management following thoracic surgery, including video assisted thoracoscopic surgery (VATS), continues to be challenging [1,2]. These patients are highly susceptible to opioid-induced over sedation and respiratory depression due to their compromised health status and impaired respiratory function.…”

Section: Introductionmentioning

confidence: 99%

“…Successful management of acute postoperative pain in thoracic surgery is a critical element of the care pathway as it reduces overall morbidity and mortality, particularly that related to pulmonary and cardiac complications [1]. However, pain management following thoracic surgery, including video assisted thoracoscopic surgery (VATS), continues to be challenging [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…These patients are highly susceptible to opioid-induced over sedation and respiratory depression due to their compromised health status and impaired respiratory function. Accordingly, opioid sparing techniques, such as multimodal analgesia, are advocated [1,3,4]. Consensus guidelines issued jointly by the American Pain Society, American Society of Regional Anesthesia, and American Society of Anesthesiologists recommend multimodal analgesia and, specifically for thoracic surgery, suggest NSAIDs, acetaminophen, gabapentin, DOI: http://dx.doi.org/10.21454/rjaic.7518.251.gab…”

Section: Introductionmentioning

confidence: 99%

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Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study

Qiu

Perrino

Zurich

et al. 2018

Rom J Anaesth Int Care

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Background: Patients undergoing video-assisted thoracoscopic surgery (VATS) are particularly vulnerable to opioid-induced sedation and hypoventilation. Accordingly, reducing opioid consumption in these patients is a primary goal of multimodal analgesic regimens. Although administration of preoperative gabapentin and acetaminophen has been shown to decrease postoperative opioid consumption in other surgeries, this approach has not been studied in VATS lobectomy. Our objective was to examine the impact of the addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic plan on postoperative opioid consumption, nausea/vomiting, and sedation.Methods: With IRB approval, we performed a retrospective chart review of patients who underwent VATS lobectomy at a single center between 2015 and 2016 to identify those that received preoperative gabapentin and acetaminophen and those that received neither. Opioid consumption in the first 24 hours postoperatively was converted to oral morphine equivalents (OMEQs). Postoperative sedation was evaluated using Aldrete scores and the percentage of patients requiring antiemetics in the first 24 hours was also examined.Results: There were 133 patients who were opioid naive: 31 received preoperative gabapentin and acetaminophen and 102 received neither. Median 24 hour postoperative opioid consumption was lower but not statistically significant in the gabapentin and acetaminophen group vs. neither (36 mg vs. 45 mg, p = 0.08). Notably, there was a change in the distribution of opioid consumption, with no patients in the gabapentin and acetaminophen group requiring more than 200 mg OMEQ in the first 24 hours postoperatively. No significant difference in postoperative nausea/vomiting or sedation was observed.Conclusions: The addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic regimen reduces the incidence of high dose postoperative opioid consumption without observed negative side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%