Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study

Chen, Sisi; Zhu, Xiaona; Huang, Lvdan; Chen, Wei; Zhang, Sainan; H, Shi; Xia, Yun; Papadimos, Thomas J; Xu, Xuzhong

doi:10.1016/j.ijsu.2019.05.013

Cited by 5 publications

(7 citation statements)

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“…The median effect time of a single administration of 0.75% ropivacaine, 15 mL or 20 mL, in the pleural cavity is 320 min; 6 50% of patients had NRS score ≥4 after 4h post administration. 6 Similarly, Ishikawa et al 13 compared the analgesic effect of intrapleural analgesia and epidural analgesia after VATS, and found that the median time interval between the first and second injection of 0.375% intrapleural ropivacaine for pain control was 180 min, with an increase in the NRS score over the ensuing 4h. The currently approved measures that can prolong the analgesic time of local anesthetics include the addition of local anesthetic adjuvants such as dexmedetomidine and dexamethasone.…”

Section: Dovepressmentioning

confidence: 99%

“…In previous studies, the median time of intrapleural analgesia with 0.75% ropivacaine 15 mL to take effect was 6 min. 6 Therefore, the thoracic drainage tube was clamped for 15 min in order to ensure the effect of ropivacaine.…”

Section: Dovepressmentioning

confidence: 99%

“…Clinical studies have confirmed the safety and effectiveness of intrapleural analgesia after thoracic surgery. [5][6][7][8] Chen et al 6 demonstrated the effectiveness of intrapleural analgesia for postoperative pain relief after thoracoscopic surgery. In that study intrapleural analgesia with 0.75% ropivacaine (15 mL or 20 mL) effectively relieved pain due to coughing after thoracoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Tetik et al 7 confirmed that an injection of 0.25% bupivacaine 40 mL via the thoracic drainage tube provided 5h of analgesia after thoracic surgery, therein making the recommendation to repeat the dose every 6h via the thoracic drainage tube. Chen et al 6 reported that the median duration of intrapleural analgesia after the administration of 0.75% ropivacaine, 15 mL and 20 mL, was 320 minutes. The concentration, dosage and the method of administration of local anesthetics affect the duration of intrapleural analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study

Chen

Cai

et al. 2021

JPR

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Background: Intrapleural analgesia has been increasingly recommended for postoperative analgesia after thoracic surgery. However, the analgesic effect provided by a single intrapleural administration is time limited. This study reports the efficacy and safety of repeated intrapleural 0.75% ropivacaine administration after thoracoscopic surgery. Methods: Twenty patients were randomly divided into two groups: a single administration group receiving a single intrapleural injection of 0.75% ropivacaine 15 mL (single administration group, SA group), and a repeated administration group with an intrapleural injection of 0.75% ropivacaine 15 mL every 4h for 4 doses (repeated administration group, RA group). The primary outcomes of this study were the peak plasma concentration of ropivacaine and 24h morphine consumption. The secondary outcomes were pain score, patient satisfaction, extubation time, hospital length of stay, and adverse reactions. Results: In SA group, the highest plasma concentration after intrapleural administration of 0.75% ropivacaine 15 mL was 1345±364 μg/L. The highest plasma concentration in RA group after the fourth administration was 1864±492 μg/L. The 24h morphine consumption in RA group was significantly less than that in SA group (9.0±5.66 vs 15.9±3.48 mg, P=0.004). The NRS scores at rest and while coughing of patients in RA group were significantly lower than those in SA group at 5, 9, 13, 17 and 24h after operation. The patients in RA group had higher satisfaction than those in SA group. There was no significant difference in postoperative adverse events, drainage tube placement days and hospital length of stay between the two groups. Conclusion: Repeated intrapleural administration with 0.75% ropivacaine, 15 mL every 4h for 4 doses after video-assisted thoracoscopic lobectomies, can provide a more durable and more effective analgesic effect than single intrapleural administration. Repeated intrapleural administration of ropivacaine is an effective postoperative method of analgesia resulting in higher patient satisfaction. Moreover, it was also able to keep the plasma concentration of ropivacaine within a possible safe range. Clinical Trial Registration Number: ChiCTR-IOR-17010560.

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Section: Dovepressmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study

Chen

Cai

et al. 2021

JPR

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“…Postoperative pain is a significant concern following video-assisted thoracoscopic surgery (VATS) [1,2]. Pain after thoracic surgery not only causes a strong stress reaction and adverse emotional experience but also affects postoperative rehabilitation [3][4][5]. Hence, different analgesia techniques, including local anesthetic infiltration, intercostal nerve block, paravertebral block, and thoracic epidural anesthesia, have been described to attenuate the intensity of acute postoperative pain [6,7].…”

Section: Introductionmentioning

confidence: 99%

Rhomboid intercostal block combined with sub-serratus plane block versus rhomboid intercostal block for postoperative analgesia after video-assisted thoracoscopic surgery: a prospective randomized-controlled trial

et al. 2021

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Background Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). This prospective randomized controlled trial was performed to analyze the postoperative analgesic effects of ultrasound-guided RIB block and RISS block after video-assisted thoracoscopic surgery. Methods Ninety patients aged between 18 and 80 years, with American Society of Anesthesiologists physical status Classes I–II and scheduled for elective unilateral VATS were randomly allocated into three groups. In group C, no block intervention was performed. Patients in group RIB received ultrasound-guided RIB with 20-mL 0.375% ropivacaine and those in group RISS received ultrasound-guided RIB and serratus plane block using a total of 40-mL 0.375% ropivacaine. All patients received intravenous sufentanil patient-controlled analgesia upon arrival in the recovery room. Postoperative sufentanil consumption and pain scores were compared among the groups. Results The dosages of sufentanil consumption at 24 h after the surgery in the RIB and RISS groups were significantly lower than that in group C (p < 0.001 and p < 0.001 for all comparisons, respectively), the postoperative Numerical Rating Scale (NRS) scores in the RIB and RISS groups at 0.5, 1, 3, 6, 12, 18, and 24 h after surgery when patients were at rest or active were significantly lower than that in group C (p < 0.05 for all comparisons). The required dosage of sufentanil and time to first postoperative analgesic request in groupRISS were less than those in the group RIB at 24 h after the surgery (p < 0.001 and p < 0.001 for all comparisons, respectively). Similarly, the Numerical Rating Scale scores for group RISS at 12, 18, and 24 h after the surgery when the patients were active were significantly lower than those for group RIB (p < 0.05 for all comparisons). Conclusion Both ultrasound-guided RIB block and RISS block can effectively reduce the demand for sufentanil within 24 h after VATS, and less sufentanil dosage is needed in patient with RISS block. Ultrasound-guided RIB block and RISS block can effectively relieve pain within 24 h after VATS, and RISS block is more effective.

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Continuous Rhomboid Intercostal Block for Thoracoscopic Postoperative Analgesia

Deng

Liu

Jiang

et al. 2022

The Annals of Thoracic Surgery

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Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study

Cited by 5 publications

References 24 publications

Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study

Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study

Rhomboid intercostal block combined with sub-serratus plane block versus rhomboid intercostal block for postoperative analgesia after video-assisted thoracoscopic surgery: a prospective randomized-controlled trial

Continuous Rhomboid Intercostal Block for Thoracoscopic Postoperative Analgesia

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