Intrapleural analgesia after endoscopic thoracic sympathectomy

Silva, Patrícia Gomes da; Catâneo, Daniele Cristina; Leite, Fernanda; Hasimoto, Érica Nishida; Barros, Guilherme Antônio Moreira de

doi:10.1590/s0102-86502011000600017

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…In accordance with these results, Silva et al . [ 6 ] reported improved pain management and decreased analgesic consumption with intrapleural block when compared to intravenous analgesia. In addition, observation of decreased pain score and opioid use in response to pain, by Assalia et al .,[ 7 ] in patients underwent thoracoscopic sympathectomy under general anesthesia with bilateral intrapleural bupivacaine analgesia.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of intrapleural with paravertebral levobupivacaine analgesia for thoracoscopic sympathectomy: A randomized controlled study

et al. 2018

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Background:Palmar hyperhidrosis is a benign disease of excessive sweating in the palm that exceeds the physiological state. Thoracoscopic sympathectomy is an effective surgical treatment for localized hyperhidrosis.Aims:The aim of this study was to compare paravertebral block (PVB) with intrapleural analgesia in thoracoscopic sympathectomy.Settings and Design:A total of 90 patients physical status American Society of Anesthesiologists Classes I or II scheduled for arthroscopic thoracoscopic sympathectomy were enrolled in this study.Subjects and Methods:Patients were randomly allocated into three groups; in the controlled (C) group, no regional block was performed. In the intrapleural (I) group or paravertebral (P) group using a volume of 20 ml of levobupivacaine 0.5%. The first request for analgesia postoperatively was our primary concern. Secondary outcomes included pain scores, the cumulative consumption of fentanyl during the 1st postoperative day, pulmonary functions, blood gases, and complications.Statistical Analysis Used:Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA).Results:First request of analgesia in paravertebral group was statistically significantly longer when compared with either control or intrapleural group. In addition, total fentanyl dose was significantly higher in control group when compared with the other groups. Groups I and P showed statistically significant less pain scores, better pulmonary function, and blood gases when compared with control group.Conclusion:We concluded that either intrapleural or paravertebral analgesia compared with control group in thoracoscopic sympathectomy resulted in later request of analgesia, improved pain control, reduced analgesic requirements postoperatively, preservation of lung function and acid-base balance. The PVB, compared to intrapleural, had an advantage of longer and effective analgesia.

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Section: Discussionmentioning

confidence: 99%

“…[ 4 5 ] Such pain make breathing and coughing difficult resulting in increased occurrence of pulmonary complications, need for analgesic, and hospital stay. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

Comparison of intrapleural with paravertebral levobupivacaine analgesia for thoracoscopic sympathectomy: A randomized controlled study

et al. 2018

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“…In one study, it was found that IPA using ropivacaine, compared to conventional analgesia, reduced pain in the late postoperative period of patients underwent thoracic sympathectomy, and when used in its higher concentration, it produced better global analgesic results and less alteration in ventilatory mechanics, thus producing a better respiratory outcome. [1819] It is well known that VATS has reduced the invasiveness of a considerable number of thoracic operations although optimal postoperative thoracic analgesia remains an open issue. Among commonly used methods, continuous intravenous infusion of analgesics, including opioids and nonsteroidal anti-inflammatory drugs, has shown promise but is not always satisfactory and can have some adverse effects.…”

Section: Intrapleural Analgesiamentioning

confidence: 99%

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

Alzahrani

2017

Saudi J Anaesth

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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.

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“…Clinical studies have confirmed the safety and effectiveness of intrapleural analgesia after thoracic surgery. [5][6][7][8] Chen et al 6 demonstrated the effectiveness of intrapleural analgesia for postoperative pain relief after thoracoscopic surgery. In that study intrapleural analgesia with 0.75% ropivacaine (15 mL or 20 mL) effectively relieved pain due to coughing after thoracoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study

Chen

Cai

et al. 2021

JPR

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Background: Intrapleural analgesia has been increasingly recommended for postoperative analgesia after thoracic surgery. However, the analgesic effect provided by a single intrapleural administration is time limited. This study reports the efficacy and safety of repeated intrapleural 0.75% ropivacaine administration after thoracoscopic surgery. Methods: Twenty patients were randomly divided into two groups: a single administration group receiving a single intrapleural injection of 0.75% ropivacaine 15 mL (single administration group, SA group), and a repeated administration group with an intrapleural injection of 0.75% ropivacaine 15 mL every 4h for 4 doses (repeated administration group, RA group). The primary outcomes of this study were the peak plasma concentration of ropivacaine and 24h morphine consumption. The secondary outcomes were pain score, patient satisfaction, extubation time, hospital length of stay, and adverse reactions. Results: In SA group, the highest plasma concentration after intrapleural administration of 0.75% ropivacaine 15 mL was 1345±364 μg/L. The highest plasma concentration in RA group after the fourth administration was 1864±492 μg/L. The 24h morphine consumption in RA group was significantly less than that in SA group (9.0±5.66 vs 15.9±3.48 mg, P=0.004). The NRS scores at rest and while coughing of patients in RA group were significantly lower than those in SA group at 5, 9, 13, 17 and 24h after operation. The patients in RA group had higher satisfaction than those in SA group. There was no significant difference in postoperative adverse events, drainage tube placement days and hospital length of stay between the two groups. Conclusion: Repeated intrapleural administration with 0.75% ropivacaine, 15 mL every 4h for 4 doses after video-assisted thoracoscopic lobectomies, can provide a more durable and more effective analgesic effect than single intrapleural administration. Repeated intrapleural administration of ropivacaine is an effective postoperative method of analgesia resulting in higher patient satisfaction. Moreover, it was also able to keep the plasma concentration of ropivacaine within a possible safe range. Clinical Trial Registration Number: ChiCTR-IOR-17010560.

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Intrapleural analgesia after endoscopic thoracic sympathectomy

Cited by 4 publications

References 25 publications

Comparison of intrapleural with paravertebral levobupivacaine analgesia for thoracoscopic sympathectomy: A randomized controlled study

Comparison of intrapleural with paravertebral levobupivacaine analgesia for thoracoscopic sympathectomy: A randomized controlled study

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

Single and Repeated Intrapleural Ropivacaine Administration: A Plasma Concentration and Pharmacodynamics Study

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