Regional analgesia for video-assisted thoracic surgery: a systematic review

Steinthorsdottir, Kristin Julia; Wildgaard, Lorna; Hansen, Henrik Jessen; Petersen, René Horsleben; Wildgaard, Kim

doi:10.1093/ejcts/ezt525

Cited by 133 publications

(103 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The surgical method of catheter insertion into the paravertebral space under the parietal pleura with fenestration of the endothoracic fascia is preferable in some centres [16]. However, the latest review of meta-analyses has revealed comparable efficacy of blocks using both techniques [4].…”

Section: Resultsmentioning

confidence: 99%

“…Epidural and paravertebral blocks show the highest efficacy in pain management after VATS lobectomy [4,5]. Both blocks were compared with other methods of analgaesia in clinical tests, yet only one study has reported on the direct comparison between them [6].…”

mentioning

confidence: 99%

“…Both blocks were compared with other methods of analgaesia in clinical tests, yet only one study has reported on the direct comparison between them [6]. Reviews devoted to the methods of regional anaesthesia after anatomical videothoracoscopic resections have raised more questions than have provided answers [4,5]. Based on a few literature publications available, it is not possible to determine conclusively the superiority of any type of anaesthesia or formulate for even general recommendations.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Kosiński¹,

Fryzlewicz²,

Wilkojc³

et al. 2016

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Background: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. Methods: Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. Results: Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). Conclusions: Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Kosiński¹,

Fryzlewicz²,

Wilkojc³

et al. 2016

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…Yet there is currently no consensus on the best strategy for treating pain after video-assisted thoracoscopic surgery (VATS) (6). Despite the reduced invasiveness when compared to the thoracotomic approach, postoperative pain after VATS must still be considered moderate-severe (7,8).…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

show abstract

“…No clear gold standard for regional analgesia for VATS could be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS was presented. [14]…”

Section: Thoracic Paravertebral Nerve Blockmentioning

confidence: 99%

Pain relief following thoracic surgical procedures: A literature review of the uncommon techniques

Alzahrani

2017

Saudi J Anaesth

View full text Add to dashboard Cite

Thoracic surgical procedures can be either thoracotomy or thoracoscopy. In thoracotomy, the incision could be either muscle-cutting or muscle-sparing incision. The posterolateral thoracotomy incision is used for most general thoracic surgical procedures. This incision, which involves division of the latissimus dorsi and serratus anterior muscles, affords excellent exposure of the thoracic cavity. However, it is associated with significant morbidity, including impaired pulmonary function, postoperative chest pain, and restricted arm and shoulder movement. Various muscle-sparing incisions have been proposed to decrease the morbidity. Postthoracotomy pain originates from pleural and muscular damage, costovertebral joint disruption, and intercostal nerve damage during surgery. Inadequate pain relief after surgery affects the quality of patient's recovery and exposes the patients to postoperative morbidities. There is a tendency nowadays among thoracic surgeons and anesthesiologists toward the area of enhanced recovery after thoracic surgery which requires careful titration of the anesthetic drugs in awake patients undergoing thoracoscopic procedures. There is a common feeling among thoracic anesthesiologists that potthoracoscopy procedures produce less pain intensity versus thoracotomy which is partially true. However, effective management of acute pain following either thoracotomy/thoracoscopy is needed and may prevent these complications and reduce the likelihood of developing chronic pain. In this report, we are going to review the newly introduced postthoracotomy/thoracoscopy pain relief modalities with special reference to the new tendency of awake thoracic surgical procedures and its impact on enhanced recovery after surgery.

show abstract

Regional analgesia for video-assisted thoracic surgery: a systematic review

Cited by 133 publications

References 34 publications

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

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

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Pain relief following thoracic surgical procedures: A literature review of the uncommon techniques

Contact Info

Product

Resources

About