Regional versus systemic analgesia in video-assisted thoracoscopic lobectomy: a retrospective analysis

Abstract

BackgroundThe optimal perioperative analgesic strategy in video-assisted thoracic surgery (VATS) for anatomic lung resections remains an open issue. Regional analgesic concepts as thoracic paravertebral or epidural analgesia were used as systemic opioid application. We hypothesized that regional anesthesia would provide improved analgesia compared to systemic analgesia with parenteral opioids in VATS lobectomy and would be associated with a lower incidence of pulmonary complications.MethodsThe study was approved by the local ethics committee (AZ 99/15) and registered (germanctr.de; DRKS00007529, 10th June 2015). A retrospective analysis of anesthetic and surgical records between July 2014 und February 2016 in a single university hospital with 103 who underwent VATS lobectomy. Comparison of regional anesthesia (i.e. thoracic paravertebral blockade (group TPVB) or thoracic epidural anesthesia (group TEA)) with a systemic opioid application (i.e. patient controlled analgesia (group PCA)). The primary endpoint was the postoperative pain level measured by Visual Analog Scale (VAS) at rest and during coughing during 120 h. Secondary endpoints were postoperative pulmonary complications (i.e. atelectasis, pneumonia), hemodynamic variables and postoperative nausea and vomiting (PONV).ResultsMean VAS values in rest or during coughing were measured below 3.5 in all groups showing effective analgesic therapy throughout the observation period. The VAS values at rest were comparable between all groups, VAS level during coughing in patients with PCA was higher but comparable except after 8–16 h postoperatively (PCA vs. TEA; p < 0.004). There were no significant differences on secondary endpoints. Intraoperative Sufentanil consumption was significantly higher for patients without regional anesthesia (p < 0.0001 vs. TPVB and vs. TEA). The morphine equivalence postoperatively applicated until POD 5 was comparable in all groups (mean ± SD in mg: 32 ± 29 (TPVB), 30 ± 27 (TEA), 36 ± 30 (PCA); p = 0.6046).ConclusionsAnalgesia with TEA, TPVB and PCA provided a comparable and effective pain relief after VATS anatomic resection without side effects. Our results indicate that PCA for VATS lobectomy may be a sufficient alternative compared to regional analgesia.Trial registrationThe study was registered (germanctr.de; DRKS00007529; 10th June, 2015).

Comparison of postoperative pain and pain control techniques in uniportal and biportal VATS and open surgery patients

“…There was not a significant difference in pain levels between these groups in our study (Table IV). Our study revealed that lung resections with uniportal incisions result in lower pain scores and pain control was comparable with systemic or epidural pain control methods in accordance with the reported experiences of different clinics in the literature [19,20]. We compared the patients in 2 groups according to the size of resection: named as wedge resection and anatomical resection.…”

Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery

“…Along with physical rehabilitation, postoperative pain management plays a key role in achieving the rapid improvement of lung function (83,84). Effective postoperative analgesic measures can promote early diaphragmatic movement, coughing, and expectoration, thereby reducing damage to lung function and decreasing pulmonary infections (85).…”

Perioperative pain management for thoracic surgery: a narrative review of the literature

“…Epidurals have been used for VATS surgery. However, the lesser surgical trauma and less intense postoperative pain compared to thoracotomy, the potential for significant side effects associated with thoracic epidural catheterization and the availability of effective, simpler regional analgesia blocks make the use of epidural analgesia questionable in this context (18)(19)(20). However, epidural placement may be considered when there is a high probability of conversion to open thoracotomy.…”