Postoperative analgesia in patients undergoing robot-assisted thoracic surgery: a comparison between thoracic epidural analgesia and intercostal nerve block combined with intravenous patient-controlled analgesia

Abstract

Background: Recently, robot-assisted thoracic surgery (RATS) is increasingly applied to lung or mediastinal tumor surgery. However, appropriate methods of postoperative analgesia for RATS have not been studied.Methods: Patients who underwent RATS at a single university hospital between January, 2017 and March, 2018 were studied retrospectively. Patients were anesthetized with either general anesthesia alone or combined general and thoracic epidural anesthesia. Accordingly, postoperative analgesia was managed with either intravenous patient-controlled analgesia (PCA) with fentanyl or thoracic epidural analgesia (TEA) with morphine and levobupivacaine. Patients were thus divided into 2 groups (PCA and TEA) according to methods of postoperative analgesia, and analgesic efficacies were compared between the groups with regard to pain scores evaluated on a 11-point numerical rating scale (NRS) at 0, 3, 6, 12, 18, 24, and 48 h postoperatively, rescue analgesic requirements within 24 h, side effects of anesthesia and analgesia, including respiratory depression, hypotension, nausea, pruritus, and urinary retention, time to ambulation after surgery, and hospital stay after surgery.Results: Data from 107 patients (76 in Group PCA and 31 in Group TEA) were analyzed. NRS pain scores at 6, 18, and 48 h were significantly less or tended to be less in Group TEA than in Group PCA (1.8±2.0 vs.

Pain management after robot-assisted minimally invasive esophagectomy

“…Regarding thoracotomies in general PVB seemed to be comparable to TEA with no difference in analgesic efficiency or major complications like hematomas but with a lower incidence of hypotension [ 36 ]. In case of robot-assisted thoracic surgery (RATS) there is some data showing lower pain scores and less use of rescue medication using TEA in comparison to PCA combined with intercostal nerve block [ 37 ]. Unknown is the optimal analgesic approach for patients undergoing RAMIE for esophageal cancer so far.…”

Comparison of desflurane and propofol in the speed and the quality of emergence from anesthesia in patients undergoing lung cancer surgery—a prospective, randomized study

“…In that study, however, nitrous oxide co-used with all three anesthetics might provoke EA even after propofol anesthesia ( 13 ). While EA occurs often after inhalational anesthesia in children ( 2 ), a meta-analysis reported that the conversion from inhalational anesthetics to propofol reduces the incidence of EA in children ( 24 ). Our present results seemed in agreement with such previous data ( 24 ).…”

“…In such patients, rapid emergence from anesthesia and adequate postoperative pain control are crucial to achieve early recovery of postoperative respiratory function. To achieve such goals in patients undergoing lung cancer surgery, general anesthesia with desflurane or propofol and remifentanil, combined with thoracic epidural anesthesia, seems a reasonable choice ( 2 ), since desflurane and propofol enable rapid emergence from anesthesia ( 3 - 13 ), adequate intraoperative analgesia provided by remifentanil and/or epidural anesthesia reduces doses of anesthetics required for anesthesia ( 14 , 15 ), ultrashort-acting remifentanil does not cause postoperative respiratory depression ( 16 ), and epidural anesthesia reduces doses of opioids required for intra- and post-operative pain control while providing adequate postoperative analgesia without causing respiratory depression ( 2 ).…”

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

“…In most RATS interventions, multimodal analgesics combined with local anesthesia of the surgical incisions are considered sufficient for pain control [32,22]. Intercostal nerve blockade and submuscular analgesic depositories may be applied additionally [33,34]. Especially patients with an increased surgical likelihood for conversion to thoracotomy should be counselled very differentiated.…”