Regional anesthesia for thoracic surgery: a narrative review of indications and clinical considerations

Sertçakacılar, Gökhan; Tire, Yasin; Kelava, Marta; Nair, Harsha K.; Lawin-O’Brien, Roberta O. C.; Turan, Alparslan; Ruetzler, Kurt

doi:10.21037/jtd-22-599

Cited by 15 publications

(5 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Given the high prevalence of opioids, their systemic administration is inevitable. One method is to combine regional or epidural anesthesia to reduce the use of systemic opioids [20]. Another approach to minimize adverse effects is to co-administer a peripheral opioid inhibitor such as naloxone, countering the effects of both exogenous and endogenous opioids [21].…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative factors on short-term outcomes in patients with non-small cell lung cancer over 60 years of age

Zhu,

Yang,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: People in China have gradually entered old age society, and the number of lung cancer cases is expected to increase annually among the elderly. This study aimed to retrospectively explore the association between perioperative factors and short-term outcomes in elderly patients with non-small cell lung cancer (NSCLC). Methods: A total of 490 elderly patients with NSCLC between January 1, 2003, and December 31, 2009, were selected. Perioperative factors were grouped and analyzed according to postoperative complications and length of hospital stay. A logistic regression analysis model was used to screen for the independent predictors of patient prognosis. The primary endpoint was postoperative complications and the secondary endpoint was postoperative hospital stay. Results: Of all patients, 344 (70.2%) developed postoperative complications, and the average length of stay after surgery was14.0±5.6 days. Perioperative fentanyl equivalents＞28.7μg/kg and duration of surgery＞4.4h were associated were associated with an increased risk of PPCs (P < 0.05);intraoperative blood loss(IBL) > 200 ml was associated with extended hospital stay (P < 0.05). Conclusions: This study suggested that Perioperative factors may affect the short-term prognosis of elderly NSCLC patients after surgery. Perioperative fentanyl equivalents＞28.7μg/kg, surgery duration, and IBL may be independent predictors of short-term outcomes in elderly patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of perioperative factors on short-term outcomes in patients with non-small cell lung cancer over 60 years of age

Zhu,

Yang,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Clinical trials have shown that SAPB can lead to slightly improved pain scores and reduced opioid consumption compared to no block or sham block [16]. Additionally, SAPB has shown hemodynamic stability during surgery, making it advantageous over PVB or thoracic epidural block [17]. However, it appears to be inferior compared to PVB or ESPB in terms of hospital LOS [6].…”

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

Hoogma,

Brullot,

Coppens

2023

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of review Thoracic surgery is evolving, necessitating an adaptation for perioperative anesthesia and analgesia. This review highlights the recent advancements in perioperative (multimodal) analgesia for minimally invasive thoracic surgery. Recent findings Continuous advancements in surgical techniques have led to a reduction in surgical trauma. However, managing perioperative pain remains a major challenge, impeding postoperative recovery. The traditional neuraxial technique is now deemed outdated for minimally invasive thoracic surgery. Instead, newer regional techniques have emerged, and traditional approaches have undergone (re-)evaluation by experts and professional societies to establish guidelines and practices. Assessing the quality of recovery, even after discharge, has become a crucial factor in evaluating the effectiveness of these strategies, aiding clinicians in making informed decisions to improve perioperative care. Summary In the realm of minimally invasive thoracic surgery, perioperative analgesia is typically administered through systemic and regional techniques. Nevertheless, collaboration between anesthesiologists and surgeons, utilizing surgically placed nerve blocks and an active chest drain management, has the potential to significantly improve overall patient care.

show abstract

“…Оскільки основною метою післяопераційного періоду є швидке одужання пацієнта, важливо забезпечити адекватне знеболювання, збереження свідомості та мобілізацію пацієнтів у ранній післяопераційний період. Цього можна досягти за допомогою мультимодального підходу до лікування хворого [25]. Пошук альтернативних методів пояснюється наявністю побічних ефектів та ускладнень методів знеболювання.…”

Section: обговоренняunclassified

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Poniatovska,

Dubrov

2023

Ukr. ìnterv. nejroradìol. hìr.

View full text Add to dashboard Cite

Objective ‒ to explore the need for additional analgesia during surgical interventions on the respiratory organs, by evaluating the consumption of opioids in the postoperative period.Materials and methods. The data of 157 patients, who underwent open surgery for lung cancer were analyzed. Patients were divided into four groups: Multimodal analgesia group (n=39): 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours with epidural analgesia using ropivacaine 2 mg/ml (3‒14 mL/h). Thoracic epidural analgesia group (n=37): epidural analgesia: in the postoperative period – ropivacaine 2 mg/ml (3‒14 mL/h). Preemptive analgesia group (n=41): according to the concept of preemptive analgesia ‒ 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period ‒ dexketoprofen and paracetamol were administered every 8 hours. Control group (n=40): patients received dexketoprofen 50 mg and, if necessary, an opioid analgesic. Pain syndrome was assessed using a visual analog scale from 0‒100 mm.Results. The lowest average dose of morphine consumption was not statistically significantly different in the multimodal analgesia and preemptive analgesia groups (p=0.933), and was significantly lower than in the control and thoracic epidural analgesia groups.Conclusions. The use of a preventive approach to perioperative analgesia in thoracic surgery, which involves the use of paracetamol and dexketoprofen, is not statistically significantly different in terms of pain indicators and the dose and number of morphine prescriptions compared to intravenous administration of paracetamol and dexketoprofen in combination with epidural ropivacaine analgesia (p>0.05).

show abstract

Regional anesthesia for thoracic surgery: a narrative review of indications and clinical considerations

Cited by 15 publications

References 84 publications

Effect of perioperative factors on short-term outcomes in patients with non-small cell lung cancer over 60 years of age

Effect of perioperative factors on short-term outcomes in patients with non-small cell lung cancer over 60 years of age

Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Contact Info

Product

Resources

About