Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy☆

Fiorelli, Alfonso; Vicidomini, Giovanni; Laperuta, Paolo; Busiello, Luigi; Perrone, Anna; Napolitano, Filomena; Messina, Gaetana; Santini, Mario

doi:10.1016/j.ejcts.2009.07.040

Cited by 36 publications

(28 citation statements)

References 25 publications

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“…In contrast, it was difficult to determine the analgesic efficacy of postoperative opioid infusion in this study. To the best our knowledge, there are no previous studies that compared the analgesic efficacy of postoperative opioid infusion with that of other reported pain treatments for VATS, i.e., nonsteroidal anti-inflammatory drugs, paravertebral block with local anesthetics, and surgical wound infiltration [15][16][17]. If one of these pain treatments or their combinations have equivalent analgesic efficacy to postoperative opioid infusion, using them instead of postoperative opioid infusion may reduce OI and facilitate early ambulation.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic intolerance during early mobilization following video-assisted thoracic surgery

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Orthostatic intolerance during early mobilization following video-assisted thoracic surgery

et al. 2013

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“…96 Both in thoracotomy and thoracoscopic surgery, LWI has shown a lower pain score, lower analgesic consumption, shorter postoperative hospital stays, higher patient satisfaction scores, earlier bowel canalization and ambulation when compared to no infiltration or placebo. 97,98 On the other hand, Karnik et al, who compared local infiltration and systemic opioids in video-assisted thoracoscopic surgery decortication in pediatric empyema patients, affirmed that LWI is not as effective as epidural block in the reduction of postoperative pain. 99 Similarly, Abo-zeid et al compared single-shot paravertebral block with local anesthetic infiltration in thoracoscopic surgery: the authors highlighted a considerable analgesic superiority of the para-neuraxial technique compared to the infiltration of the surgical site in terms of postoperative pain reduction, leading to a better respiratory function (FEV1).…”

Section: Cardiothoracic Surgerymentioning

confidence: 99%

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patientcontrolled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/ laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.

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“…Previous studies have confirmed that preemptive analgesia could decrease rates of hyperalgesia and allodynia by normalizing altered central sensory processing. 40 Parecoxib is a selective COX-2 inhibitor that is less likely to cause gastrointestinal bleeding and acute kidney injury. 41 It can reduce the production and synthesis of spinal prostaglandin, which may be involved in the pathological processes of inflammation, pain, and apoptosis.…”

Section: Discussionmentioning

confidence: 99%

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Yang¹,

Hao²,

Li³

et al. 2020

JPR

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Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

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Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy☆

Cited by 36 publications

References 25 publications

Orthostatic intolerance during early mobilization following video-assisted thoracic surgery

Orthostatic intolerance during early mobilization following video-assisted thoracic surgery

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

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