Background: Thoracotomy is a very painful surgical procedure that is used to get access into the pleural space, to the lungs, to the heart, to the esophagus or to get access to the thoracic aorta or anterior mediastinum. Objective: To study different modalities of treatment used for post thoracotomy pain control. Recent Findings: Inadequate post-thoracotomy analgesia enhances the postoperative stress response with deleterious effects on respiratory, cardiovascular, gastrointestinal, urinary, immune and coagulation systems. In addition to anxiety and increased risk of Post Thoracotomy Pain Syndrome (PTPS), which can interfere with normal life and may persist for years or even for life? Conclusion: Providing adequate post-thoracotomy analgesia can be challenging, as patients are often elderly or having multiple comorbidities. A multimodal approach is considered in managing post-thoracotomy pain starting with preemptive analgesia and cognitive behavioral modalities in addition to conventional multimodal systemic regimens as opioids, acetaminophen, NSAID, cyclooxygenase (COX)-2-specific inhibitors, gabapentin and pregabalin, steroids, IV lidocaine infusion, ketamine, and many regional analgesic modalities to avoid or decrease adverse effects of systemic regimens. These regional analgesic modalities include thoracic epidural blocks, thoracic paravertebral blocks, intrathecal opioid analgesia, serratus anterior plane blocks, intercostal nerve blocks, interscalene block, erector spinae block and interpleural block.
BACKGROUND: Postdural puncture headache (PDPH) is a complication commonly related to neuraxial anesthesia and dural puncture, with an incidence proportional to the diameter of the needle, ranging from 2% with a 29G to 10% with a 27G and 25% with a 25G. The development of ne gauge spinal needles and needle tip modication, has enabled a signicant reduction in the incidence of postdural puncture headache. PDPH presents as a dull throbbing pain with a frontal-occipital distribution. PDPH is thought to be due to a cerebrospinal uid leak that exceeds the production rate, causing downward traction of the meninges and parasympathetic mediated reex vasodilatation of the meningeal vessels. The sphenopalatine ganglion (SPG) is an extracranial neural structure located in the pterygopalatine fossa that has both sympathetic and parasympathetic components as well as somatic sensory roots. Sphenopalatine ganglion block (SPGB) has been used for the treatment of migraine, cluster headache and trigeminal neuralgia and can be performed through transcutaneous, transoral or transnasal approaches. Obstetric patients are considered at increased risk for this condition because of their sex, young age, and the widespread use of neuraxial blocks. SPGB is minimally invasive, carried out at the bedside without using imaging and has apparently rapid onset than EBP with better safety prole. The most common side effects of SPGB are all temporary, including numbness in the throat, low blood pressure and nausea. OBJECTIVES: We evaluated the efcacy and safety of lidocaine 2%, lidocaine 5% and bupivacaine 0.5% in transnasal sphenopalatine ganglion block for the treatment of post dural puncture headache on 30 patients. PATIENTS AND METHODS: This prospective, randomized and controlled clinical study was conducted at Sohag University Hospital after its approval by the Ethics and Research Committee of Sohag Faculty of Medicine. Written informed consent was obtained from each patient before participation. RESULTS: Our study showed that there were non signicant differences between the three studied groups regarding age, gender, body mass index, type of operation, onset, site of headache, associated symptoms, relieving factors and exaggerated follow up. There was a nonsignicant difference between the three studied groups regarding changes in visual analogue score for severity of headache. There were nonsignicant differences between the three studied groups regarding presence of bleeding and results of treatment of postdural puncture headache. CONCLUSION: SPGB is an effective initial modality for managing severe headache in patients with PDPH.
Background: Pain after surgery decreases the quality of life and has also been reported as being the main source of concern for cardiac surgery patients. It was stated that patients with higher anxiety and depression levels after operation have higher requirements of analgesics for postoperative pain. Reduction of pain and anxiety after cardiac surgery is valuable for the healing process and improvement of the overall experience. Objective: To determine if the multimodal regimen of dexamethasone, gabapentin, ibuprofen, ketorolac, and paracetamol was with less complications following open-cardiac surgeries compared to IV morphine. Patients and Methods: Sixty patients were scheduled for sternotomy elective open-heart surgeries. The patients were randomized to one of two groups (ratio 1:1) utilizing sealed envelopes by the study coordinator.30 patients in each group. This prospective, randomized, and a controlled clinical trial was performed at Sohag University Hospital. Results: Patients in the multimodal group suffered fewer major in-hospital complications than in the morphine group. Acute coronary syndrome had occurred in (one versus zero) patients with a percentage of (3.3%) in the morphine group. Cardiac tamponade had occurred in (two versus one) patients with a percentage of (6.7%) in the morphine group and was with a percentage of (3.3%) in the multimodal group with (p-value) of (0.554). The duration of hospital stays was with M± SD of (7±1.72) days among the multimodal group versus (11±1.6) days in the morphine group, with (a p-value) of (<0.001). Conclusions: Patients in the multimodal group suffered less major in-hospital complications than in the morphine group after cardiac surgeries.
Background: Chest wall surgeries are accompanied by severe postoperative pain. Inadequate relief of this pain may lead to both pulmonary complications as lung atelectasis and infection and chronic post thoracotomy pain syndrome. Regional analgesic modalities are important portion of the multimodal therapeutic approach suggested for the management of post thoracotomy pain. Objective: To evaluate serratus anterior plane block as a regional analgesia technique for post thoracotomy and thoracoscopy pain. Recent Findings: Serratus anterior plane block (SAPB), a regional analgesic modality developed by Blanco et al. in 2013, has shown good analgesic effect after thoracotomy and thoracoscopy in many case reports and clinical trials. In such block, a local anesthetic is injected in the fascial plane deep or superficial to the serratus anterior muscle leading to block of lateral cutaneous branches of the intercostal nerves. This provides a sensory block of T2-T9 dermatomes. Conclusion: Serratus anterior plane block as a fascial plane block can be a preferred regional analgesia technique for both post-operative pain management with procedures involving anterolateral chest wall as thoracotomy, thoracoscopy and breast surgery and in cases of multiple rib fractures. This is owing to its easy technique, effective pain relief and potentially better side effects profile compared to other regional modalities and systemic opioids.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.