Analgesia following Thoracotomy: A Survey of Australian Practice

Abstract

This survey examines pain management after thoracotomy in Australian hospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in the analyses. Seventy-two percent of respondents were from hospitals with acute pain services (APS), and in 94% of these hospitals patients are reportedly visited by the APS. The most frequently used analgesic modalities are epidural analgesia, intravenous patient-controlled analgesia (IVPCA), and nurse-controlled intravenous opioid infusions. Over half of the anaesthetists reported using local anaesthetic intercostal nerve block, non-steroidal anti-inflammatory drugs (NSAIDs), or paracetamol. Combinations of analgesic techniques were cited frequently. Respondents reported that cryoanalgesia, interpleural blockade, paravertebral blockade, subarachnoid infusions, ketamine, and transcutaneous electrical nerve stimulation are used infrequently. Anaesthetists from public hospitals reported using epidural analgesia, IVPCA and NSAIDs more frequently than those from private hospitals. When epidural analgesia is used, most respondents place the catheter in the mid-thoracic region (91%), use a regimen of opioids plus local anaesthetic (96%), use a constant infusion technique (100%), and continue analgesia for up to three days (83%). Over half of the respondents reported that post-thoracotomy patients are nursed in a highdependency area. Seventy-nine percent of respondents selected epidural analgesia as the best available analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently ‡ .

Analgesic techniques following thoracic surgery: a survey of United Kingdom practice

“…A survey of analgesic techniques, after thoracotomy, in Australian hospitals showed that 79% of respondents regarded epidural blockade as the best available technique. 2 A similar survey in the United Kingdom by Cook and Eaton 7 showed that epidural analgesia was the most frequently used form of regional analgesia technique used after thoracotomy. Although epidural analgesia was the favoured technique used by nearly half of the respondents, paravertebral blocks combined with PCA morphine is fast gaining acceptance as a viable alternative to epidural analgesia in open thoracotomy procedures (Fig.…”

“…It must provide good analgesia during deep breathing and movement to allow coughing and physiotherapy. 2 Epidural analgesia has long been considered as the 'gold standard' among regional anaesthetic techniques for providing pain relief after thoracotomy. A survey of analgesic techniques, after thoracotomy, in Australian hospitals showed that 79% of respondents regarded epidural blockade as the best available technique.…”

“…It is particularly important to optimize postoperative analgesia in these patients, as poor analgesia contributes to further deterioration. 2 A variety of systemic and regional methods of analgesia have been described for post-thoracotomy pain. 3,4 The aim of this national survey was to determine the current practice of postoperative analgesia after major thoracic procedures in the United Kingdom.…”

Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: TOPIC feasibility study protocol

“…A survey of Australian thoracic anaesthetists in 1997 revealed that 79% regarded TEB as the method of choice for analgesia in thoracotomy 15. Similar results were found in the UK with 80% of anaesthetists considered TEB as the best mode of pain relief for upper abdominal surgery 16.…”

Analgesia in post-thoracotomy patients: Comparison between thoracic epidural and thoracic paravertebral blocks

“…[19] A similar survey of UK practice, after upper abdominal surgery, found that 80% of anesthetists considered epidural analgesia to be the best mode of pain relief. [20] Researchers have shown thoracic PVB to be an effective form of analgesia after thoracotomy.…”