Acute pain management for patients undergoing thoracotomy

Soto, Roy G.; Fu, Eugene S.

doi:10.1016/s0003-4975(02)04647-7

Cited by 138 publications

(103 citation statements)

References 80 publications

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“…Given the fact that systemic opioids are not potent enough to control neurogenic pain without detrimental effects on respiratory outcome [2], epidural analgesia is considered as the gold standard for thoracic analgesia [3].…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Fibla

Molins

Mier

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Post-thoracotomy analgesia combining paravertebral catheter and a nonsteroidal anti-inflammatory drug is a safe and effective practice, VAS values are acceptable (only 16% of patients required meperidine as rescue). It prevents the risk of side effects related to epidural analgesia. Patients submitted to AT experienced less pain than those with PT (4.5 vs 5.9, p<0.01). Bupivacaine got slightly better VAS values than ropivacaine (4.9 vs 5.4 p<0.05). Higher doses and volumes of local anesthetic could be used to obtain better VAS values.

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Section: Introductionmentioning

confidence: 99%

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Fibla

Molins

Mier

et al. 2008

European Journal of Cardio-Thoracic Surgery

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show abstract

“…Indeed, postoperative inotrope requirements were decreased by high-dose opioids in neonates after cardiac surgery, 104 and postoperative respiratory compromise associated with the pain of a thoracotomy can be relieved by adequate analgesia. 105,106 Because of the physiologic and metabolic immaturity of the neonate, doses of medications that are effective for the reduction of pain may be close to the doses that cause toxicity. Therefore, the concept of a "balanced analgesia" has arisen, whereby several approaches to pain reduction can be used simultaneously to decrease the dosage required of each medication and, thereby, reduce toxicity.…”

Section: Reducing Pain From Surgerymentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

414

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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“…The pain that is caused by stretching costovertebral, costotransverse ligaments and posterior spinal muscles, causes many complications such as weak coughing, decrease in tidal volume and atelectasia, hypoxemia, postoperative pulmonary infection and dyspnea. These complications increase according to age, smoking, obesity and other illnesses 8,9 . Post-thoracotomy pain is one of the most painful procedures and various methods have been used and new studies are being done for better methods.…”

Section: Discussionmentioning

confidence: 99%

Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

Mercanoğlu¹,

Alanoğlu²,

Ekmekçi³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. Methods: Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphineropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30 th , and 72 nd hour. Results: Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48 th hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30 th and 60 th minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30 th minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. Conclusions: Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

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Acute pain management for patients undergoing thoracotomy

Cited by 138 publications

References 80 publications

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%☆

Prevention and Management of Pain in the Neonate: An Update

Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

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