The Effectiveness of Preemptive Analgesia Varies According to the Type of Surgery: A Randomized, Double-Blind Study

SynopsisPain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the 'gold standard' for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management.

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“…One explanation offered is that the surgical area is innervated by multiple segmental and cranial nerves (89).…”

Section: Preemptive Analgesia and Thoracotomymentioning

confidence: 99%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

227

130

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“…[1][2][3][4] However, the results of the intraoperative use of TEA in combination with general anesthesia are still controversial with respect to a reduction of postoperative pain perception or postoperative analgesic consumption. [5][6][7][8][9][10] This can be explained in part by the variety of types and sites of surgery, 11 or by the presence or absence of pain before surgery. 12 In a recently published review Moiniche et al pointed out that preemptive continuous epidural treatment extending into the postoperative period might have an improved capacity to reduce nociceptive input and thereby central neuroplasticity caused not only by incision and ongoing surgery but also by postsurgical inflammation.…”

Section: Me Et Th Ho Od Ds S:mentioning

confidence: 99%

Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery

Burmeister

Gottschalk

Freitag

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Thoracic epidural analgesia (TEA) is an established technique for postoperative pain relief after major abdominal surgery. However it is still under discussion whether pre-incisional TEA can reduce postoperative pain perception or postoperative analgesic consumption. M Me et th ho od ds s: :The present prospective, randomized, double-blind study was performed to investigate the effects of intra-and postoperative TEA vs only postoperative TEA using ropivacaine 0.375% in 30 women scheduled for major abdominal tumour surgery. Prior to induction of general anesthesia patients received an epidural bolus of 10 mL saline in Group I (GI) and 10 mL ropivacaine 0.375% in Group II (GII) followed by an infusion of 6 mL·hr -1 of the respective solution during surgery. Postoperatively all patients received an epidural infusion of 6 mL·hr -1 ropivacaine 0.375% during 24 hr followed by patient controlled epidural analgesia for the next 72 hr. Operative data, dynamic pain scores, consumption of local anesthetics and standardized supplemental analgesics were analyzed. R Re es su ul lt ts s: : No difference was seen between groups with respect to the amount of required postoperative local anesthetics and supplemental analgesics, pain scores and side effects during the first 96 hr following surgery except a reduction of intraoperative sufentanil consumption (GI: 143.2 ± 52.6 vs GII: 73.3 ± 32.6 µg, P < 0.001).C Co on nc cl lu us si io on n: : Intraoperative TEA with ropivacaine 0.375% did not significantly reduce the amount of analgesics required after major abdominal gynecological tumour surgery. (GI : 143,2 ± 52,6 vs GII : 73,3 ± 32,6 µg, P < 0,001 Objectif : L'analgésie péridurale thoracique (APT) est

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“…Os nervos espinhais segmentares emergem de T 5-11 (nervos esplâncnicos, via gânglio celíaco), de T 9 -L 2 (nervo esplâncnico lombar via gânglios mesentéricos superiores e inferiores) e de S 2-4 (nervos parassimpáticos sacrais), enquanto os heterossegmentares espinhais emergem de C 3-4 (nervo frênico) e das raízes cranianas (nervo vago). As extremidades e as mamas são inervadas apenas pelos nervos segmentares e os estímulos provenientes dessas áreas podem ser melhor bloqueados por morfina peridural, o que explica a analgesia preemptiva ser evidenciada nessas operações 95 . Esse estudo também contribuiu para o entendimento de diferenças entre estudos experimentais realizados em animais e estudos clínicos.…”

Section: Periduralunclassified

“…Segmental spinal nerves emerge from T 5-11 (splanchnic nerves via celiac ganglia), from T 9 -L 2 (lumbar splanchnic nerve via upper and lower mesenteric ganglia) and from S 2-4 (sacral parasympathetic nerves), while heterosegmental spinal nerves emerge from C 3-4 (phrenic nerve) and cranial roots (vagus nerve). Extremities and breasts are innervated only by segmental nerves and stimuli in those areas may be better blocked with epidural morphine, thus explaining preemptive analgesia in such surgeries 95 . This study has also contributed for the understanding of differences among experimental and clinical trials.…”

Section: Anti-inflammatory Drugsmentioning

confidence: 99%