Pain Amelioration after Thoracotomy: A Prospective, Randomized Study

Rocha, Andrés; Chambers, Karinn

doi:10.1016/s0003-4975(10)60332-3

“…The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded (5 were not written in the English language, 4 included interventions that were mislabeled as ICNB, 3 did not include a group of patients who received ICNB with local anesthesia, 3 were systematic reviews, 2 were editorials or short reports, 1 examined outcomes outside the scope of the present study, 1 had insufficient reporting, and 1 examined nonthoracic surgery). All of the remaining 66 studies 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ,…”

Section: Resultsmentioning

confidence: 99%

“…Among 66 studies 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

Section: Resultsunclassified

Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

Guerra-Londono

¹

,

Privorotskiy

²

,

Cozowicz

³

et al. 2021

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IMPORTANCEThe use of intercostal nerve block (ICNB) analgesia with local anesthesia is common in thoracic surgery. However, the benefits and safety of ICNB among adult patients undergoing surgery is unknown. OBJECTIVE To evaluate the analgesic benefits and safety of ICNB among adults undergoing thoracic surgery.DATA SOURCES A systematic search was performed in Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library databases using terms for ICNB and thoracic surgery (including thoracic surgery, thoracoscopy, thoracotomy, nerve block, intercostal nerves). The search and results were not limited by date, with the last search conducted on July 24, 2020.STUDY SELECTION Selected studies were experimental or observational and included adult patients undergoing cardiothoracic surgery in which ICNB was administered with local anesthesia via single injection, continuous infusion, or a combination of both techniques in at least 1 group of patients. For comparison with ICNB, studies that examined systemic analgesia and different forms of regional analgesia (such as thoracic epidural analgesia [TEA], paravertebral block [PVB], and other techniques) were included. These criteria were applied independently by 2 authors, and discrepancies were resolved by consensus. A total of 694 records were selected for screening. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items forSystematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data including patient characteristics, type of surgery, intervention analgesia, comparison analgesia, and primary and secondary outcomes were extracted independently by 3 authors. Synthesis was performed using a fixed-effects model. MAIN OUTCOMES AND MEASURESThe coprimary outcomes were postoperative pain intensity (measured as the worst static or dynamic pain using a validated 10-point scale, with 0 indicating no pain and 10 indicating severe pain) and opioid consumption (measured in morphine milligram equivalents [MMEs]) at prespecified intervals (0-6 hours, 7-24 hours, 25-48 hours, 49-72 hours, and >72 hours). Clinically relevant analgesia was defined as a 1-point or greater difference in pain intensity score at any interval. Secondary outcomes included 30-day postoperative complications and pulmonary function. RESULTSOf 694 records screened, 608 were excluded based on prespecified exclusion criteria.The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded. All of the 66 remaining studies (5184 patients; mean [SD] age, 53.9 [10.2] years; approximately 59% men and 41% women) were included in the qualitative analysis, and 59 studies (continued)

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“…By this way, spinal nerves from T1 through T 11 can be blocked effectively decreasing VAS pain scores significantly. Local anesthetics can be infused as a single dose just before closure of the thoracotomy (11,(33)(34)(35)(36), as a single (37) or multiple (38) percutaneous injections or via an indwelling intercostal catheter (39)(40)(41). Intercostal blockade can reduce opioid requirements, however, cannot eliminate them.…”

Section: Intercostal Blockadementioning

confidence: 99%

Postoperative pain management

1998

Acta Anaesthesiol Scand

0

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Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesiarelated complications or side effects.

show abstract

“…By this way, spinal nerves from T1 through T 11 can be blocked effectively decreasing VAS pain scores significantly. Local anesthetics can be infused as a single dose just before closure of the thoracotomy (11,(33)(34)(35)(36), as a single (37) or multiple (38) percutaneous injections or via an indwelling intercostal catheter (39)(40)(41). Intercostal blockade can reduce opioid requirements, however, cannot eliminate them.…”

Section: Intercostal Blockadementioning

confidence: 99%

“…Antero-lateral thoracotomy and median sternotomy are associated with less postoperative pain in comparison with the postero-lateral thoracotomy (9). However, the major disadvantage of median sternotomy is the limited access to some intrathoracic structures (10,11). The classical thoracotomy is more painful than the mini thoracotomy, because classical thoracotomy is a longer incision and the tissue trauma is more extended.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Management

&NA;

1993

Anesthesia & Analgesia

0

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Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesiarelated complications or side effects.

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Pain Amelioration after Thoracotomy: A Prospective, Randomized Study

Cited by 19 publications

References 8 publications

Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

Postoperative pain management

Postoperative Pain Management

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