Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: Comparison of epidural PCA and intravenous PCA

Abstract

Our results indicated that the necessity of pain control was higher on POD1 for VATS lobectomy. Both EPCA and IVPCA can provide an adequate, continuous and effective means for postoperative pain management and a lower VAS-M was found in EPCA on POD2.

Efficacy of subpleural continuous infusion of local anesthetics after thoracoscopic pulmonary resection for primary lung cancer compared to intravenous patient-controlled analgesia

“…The total volume of the chamber is 250 mL, enabling pain control for up to 60 hours. The ON-Q system can provide sufficient analgesia in the immediate postoperative period because the NPIS score postoperatively is usually highest on the day of surgery and decreases gradually over time (11). Our results are supported by previous reports; Ried et al (1) compared the ON-Q system and thoracic epidural analgesia after thoracic surgery and reported effective pain control after thoracotomy with the ON-Q system.…”

“…Unlike other studies, the consistency of patients is an advantage of our study. Previous studies enrolled patients who underwent different surgical procedures, such as lobectomy, wedge resection, or pleurodesis (11). We limited the study group to patients with primary lung cancer who underwent thoracoscopic pulmonary resections, and a single surgeon performed all of the operations using a standard operative technique.…”

“…There are several options for analgesia after thoracic surgery, including thoracic epidural anesthesia, thoracic paravertebral blockade, IV-PCA, local anesthetic infusion in the wound or extrapleural space, and combinations of these methods (6,10). Epidural PCA has proven to be effective for pain control (6,11,12), but thoracic epidural catheterization has risks of dural puncture, epidural hematoma formation, nerve damage, hypotension, and unsuccessful catheter placement (7). The catheterization also takes time and the success rate usually depends on operator experience.…”

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

“…Analysis of the literature revealed only five randomised and two observational clinical trials concerning the lung resections of comparable extents that can be compared with our findings. Four of those mentioned above focused exclusively on lobectomy [9,10,16,17], and three dealt with mixed procedures (lobectomies, segmentectomies, and wedge resections) [6,11,18]. Continuous paravertebral block and continuous epidural anaesthesia have been compared in only one of the cited studies [6].…”

“…Therefore, it is reasonable and justified to use the methods of regional anaesthesia with continuous drug infusions providing even and long-term analgaesic effects, enabling continuous and steady convalescence. Continuous epidural thoracic anaesthesia is considered the gold standard of analgaesia after thoracotomy and is routinely used after VATS in many centres [6,[9][10][11]. The results of meta-analyses and reviews have demonstrated that paravertebral anaesthesia is characterised by comparable (if not higher) efficacy and a more favourable safety profile [1,2].…”