Postoperative Epidural Bupivacaine-Morphine Therapy Experience with 4,227 Surgical Cancer Patients

León-Casasola, Óscar A. de; Parker, Brian M.; Lema, Mark J.; Harrison, Patricia; Massey, J.

doi:10.1097/00000542-199408000-00015

Cited by 157 publications

(67 citation statements)

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“…Our findings that intercostal block patients experience hypotension less often are in accordance with previous research. Several studies suggest that hypotension is not observed frequently and that the incidence of hypotension is similar in both the thoracic epidural and the intercostal block groups [23][24][25]27]. We did not encounter any complications attributable to intercostal catheters.…”

Section: Discussionmentioning

confidence: 48%

“…Respiratory depression is a rare adverse effect of the use of thoracic epidural analgesia; however, the patients in this group need to be monitored in intensive care units [4,23,25]. Urinary retention is an adverse effect of the use of both epidural catheters and opioid analgesics, but we were not able to observe this clinical finding, as all our patients had urinary catheters during the first 24 postoperative hours [19,23,27].…”

Section: Discussionmentioning

confidence: 83%

“…The reported adverse effects associated with thoracic epidural analgesia, as confirmed by a large series of patients, include: hypotension (3%), nausea (22%), and pruritus (22%) (23). The most significant advantage of intercostal block is that it is technically easier to perform and is not associated with hypotension [4].…”

Section: Discussionmentioning

confidence: 97%

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Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Sagiroglu¹,

Baysal²,

Kiraz³

et al. 2013

kitp

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StreszczenieCel pracy: Celem pracy było porównanie skuteczności ciągłe-go stosowania znieczulenia zewnątrzoponowego piersiowego oraz blokady międzyżebrowej do leczenia bólu po torakotomii. Materiał i metody: Sześćdziesięciu chorych ukończyło prospektywne badanie z randomizacją przeprowadzone metodą podwójnie ślepej próby. Pacjentów losowo przydzielono do grupy otrzymującej piersiowe znieczulenie zewnątrzoponowe (grupa 1., n = 30) lub blokadę międzyżebrową (grupa 2., n = 30) przez 24 godziny. W obu grupach podawano bupiwakainę o stężeniu 0,25% w ilości 5 ml/godzinę przy użyciu cewnika. W celu oceny bólu użyto wizualnej skali analogowej w spoczynku (VAS-R) i po kaszlu (VAS-C). Wyniki pobrano na począt-ku badania, jak również 1, 6 i 24 godziny po zabiegu. Zebrano także dane dotyczące zużycia morfiny, powikłań i efektów niepożądanych. Wyniki: Wartości VAS-R i VAS-C na początku były podobne, jednak wyniki uzyskane po upływie 1, 6 i 24 godzin były znacząco niższe w grupie 1. niż w grupie 2. (odpowiednio p = 0,017, p = 0,001, p = 0,023 dla VAS-R oraz p = 0,006, p = 0,002, p = 0,032 dla VAS-C). Zużycie morfiny na 24 godziny w grupie 1. było niższe w porównaniu z grupą 2. (p = 0,032). W grupie 1 u 5 z 30 pacjentów (17%) wystąpiło niedociśnienie, w grupie 2. nie zanotowano takich przypadków (p = 0,02). Wniosek: W przypadku bólu po torakotomii lepszą kontrolę analgezji uzyskuje się za pomocą znieczulenia zewnątrzopo-nowego piersiowego, jednak blokada międzyżebrowa stanowi alternatywę, ponieważ jest związana z mniejszą częstością występowania niedociśnienia. Słowa kluczowe: ból, torakotomia, znieczulenie zewnątrzopo-nowe piersiowe, blokada nerwu międzyżebrowego. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 244 ANAESTHESIOLOGY AND INTENSIVE CARE AbstractAim of the study: We aimed to compare the efficacy of the continuous use of thoracic epidural and intercostal analgesia for post-thoracotomy pain. Material and methods: Sixty patients completed a prospective, randomized, double-blinded study. The patients were randomized to receive thoracic epidural (group 1, n = 30) or intercostal block (group 2, n = 30) for 24 hours. In both groups, 0.25% bupivacaine was infused at a rate of 5 ml/h through an inserted catheter. Visual analog scale at rest (VAS-R) and after coughing (VAS-C) scores were recorded at baseline and at 1, 6 and 24 hours after surgery to evaluate pain. Morphine consumption, complications and side effects were recorded as well. Results: VAS-R and VAS-C scores were similar at baseline; however, 1 st , 6 th and 24 th hour scores of group 1 were significantly lower than the scores of group 2 (for VAS-R; p = 0.017, p = 0.001, p = 0.023, for VAS-C; p = 0.006, p = 0.002, p = 0.032, respectively). 24-hour morphine consumption was lower in group 1 in comparison to group 2 (p = 0.032). In group 1, 5 out of 30 patients (17%) experienced hypotension, compared with none in group 2 (p = 0.02). Conclusions: For post-thoracotomy pain, better control of analgesia is observed with the thoracic epidural technique; however, i...

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 83%

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Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Sagiroglu¹,

Baysal²,

Kiraz³

et al. 2013

kitp

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“…This combination allowed preemptive and better perioperative analgesia. 12,13 In the latter years of the study, continuous patient-controlled epidural analgesia became available to the patient for 72-96 hours postoperatively. Intramuscular rescue NSAIDs and oral cyclooxygenase-2 inhibitors were also available upon patient request.…”

Section: Anesthesia and Perioperative Pain Controlmentioning

confidence: 99%

Role of adjuvant cryosurgery in intralesional treatment of sacral tumors

Kollender

Meller

Bickels

et al. 2003

Cancer

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BACKGROUNDCryosurgery is an adjuvant surgical technique for the treatment of benign aggressive, low‐grade malignant and metastatic tumors of long bones. It has been used rarely to treat sacral tumors, mainly because of potential damage to nerves, blood vessels, and intrapelvic organs. The authors described their experience with this procedure and provided medium and long‐term follow‐up results.METHODSFifteen procedures of cryosurgery of the sacrum were performed in 14 patients to improve the therapeutic outcome of a variety of tumors. The patient group included 7 males and 7 females with a mean age of 42 ± 24 years. Three patients were younger than 20 years of age. The procedures were performed at the Tel Aviv Sourasky Medical Center between January 1991 and January 1999. There were seven benign aggressive lesions (four giant cell tumors and three aneurysmal bone cysts), one benign schwannoma, one low‐grade chondrosarcoma, five metastatic carcinomas, and one high‐grade Ewing sarcoma, all localized at level S2 or higher. Eight of the bone tumors also involved significant anterior or posterior soft tissue. All patients had severe preoperative pain radiating to the buttocks, perineum, and lower limbs and 9 (64%) patients had bladder and/or rectal dysfunction. Invasive diagnostic procedures and radiation (if warranted) preceded surgery. Sacral posterior fenestration and burr drilling were followed by two‐cycle cryosurgery using the open pour technique or the argon‐helium–based heat‐freeze system.RESULTSAll interventions were performed under combined general and regional anesthesia and concluded uneventfully with moderate blood loss. Thirteen patients were discharged home after 8 ± 5 days (one patient remained hospitalized for 30 days). Only two patients experienced local disease recurrence during a 3–11‐year follow‐up period: one was retreated successfully by cryosurgery and the other underwent sacrectomy and radiotherapy elsewhere, with a subsequent loss of visceral functions. No patient suffered chronic pain, deep wound infections, or significant neurologic deficits and all were satisfied with the esthetic outcome.CONCLUSIONSCryosurgery is a conservative, feasible, and safe adjuvant technique in the treatment of sacral tumors. It is associated with minimal permanent neurologic and vascular injury compared with sacrectomy. Cancer 2003;97:2830–8. © 2003 American Cancer Society.DOI 10.1002/cncr.11383

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“…For acute stage postoperative pain control, various modalities including oral analgesic agents, intramuscular morphine injection, intercostal nerve blockade, and epidural analgesia have been used in thoracotomy and video-assisted thoracoscopic surgery (VATS) patients (1)(2)(3). Effective pain control can reduce not only postoperative pulmonary complications but also patients' fear of surgery.…”

Section: Introductionmentioning

confidence: 99%

Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection

Hsieh¹,

Wang²,

Liu³

et al. 2016

J. Thorac. Dis.

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Background: Effective postoperative pain control for thoracic surgery is very important, not only because it reduces pulmonary complications but also because it accelerates the pace of recovery. Moreover, it increases patients' satisfaction with the surgery. In this study, we present a simple approach involving the safe placement of intercostal catheter (ICC) after single port video-assisted thoracoscopic surgery (VATS) anatomic resection and we evaluate postoperative analgesic function with and without it.Methods: We identified patients who underwent single port anatomic resection with ICC placed intraoperatively as a route for continuous postoperative levobupivacaine (0.5%) administration and retrospectively compared them with a group of single port anatomic resection patients without ICC.The operation time, postoperative day 0, 1, 2, 3 and discharge day pain score, triflow numbers, narcotic requirements, drainage duration and post-operative hospital stay were compared.Results: In total, 78 patients were enrolled in the final analysis (39 patients with ICC and 39 without).We found patients with ICC had less pain sensation numerical rating scale (NRS) on postoperative day 0, 1 (P=0.023, <0.001) and better triflow performance on postoperative day 1 and 2 (P=0.015, 0.032). In addition, lower IV form morphine usage frequency and dosage (P=0.009, 0.017), shorter chest tube drainage duration (P=0.001) and postoperative stay (P=0.005) were observed in the ICC group.Conclusions: Continuous intercostal nerve blockade by placing an ICC intraoperatively provides effective analgesia for patients undergoing single port VATS anatomic resection. This may be considered a viable alternative for postoperative pain management.

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Postoperative Epidural Bupivacaine-Morphine Therapy Experience with 4,227 Surgical Cancer Patients

Cited by 157 publications

References 0 publications

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Role of adjuvant cryosurgery in intralesional treatment of sacral tumors

Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection

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