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

Mukherjee, Maitreyee; Goswami, Anupam; Gupta, Sanjeev; Sarbapalli, Debabrata; Pal, Ranabir; Kar, Sumit

doi:10.4103/0259-1162.73511

Cited by 12 publications

(3 citation statements)

References 23 publications

(21 reference statements)

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“…In general, studies show that reducing pain with various analgesic regimens has been successful in the acute postoperative period. 41,42 When those patients were followed up to examine the long-term effect, incidences of chronic pain were usually not different. 43–48 Regional techniques like epidural analgesia continue to have a role in reducing acute pain and acute postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Chronic Pain after Thoracic Surgery

et al. 2017

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Background The goal of this study was to detect the predictors of chronic pain at 6 months after thoracic surgery from a comprehensive evaluation of demographic, psychosocial, and surgical factors. Methods Thoracic surgery patients were enrolled 1 week before surgery and followed up 6 months postsurgery in this prospective, observational study. Comprehensive psychosocial measurements were assessed before surgery. The presence and severity of pain were assessed at 3 and 6 months after surgery. One hundred seven patients were assessed during the first 3 days after surgery, and 99 (30 thoracotomy and 69 video-assisted thoracoscopic surgery, thoracoscopy) patients completed the 6-month follow-up. Patients with versus without chronic pain related to thoracic surgery at 6 months were compared. Results Both incidence (P = 0.37) and severity (P = 0.97) of surgery-related chronic pain at 6 months were similar after thoracotomy (33%; 95% CI, 17 to 53%; 3.3 ± 2.1) and thoracoscopy (25%; 95% CI, 15 to 36%; 3.3 ± 1.7). Both frequentist and Bayesian multivariate models revealed that the severity of acute pain (numerical rating scale, 0 to 10) is the measure associated with chronic pain related to thoracic surgery. Psychosocial factors and quantitative sensory testing were not predictive. Conclusions There was no difference in the incidence and severity of chronic pain at 6 months in patients undergoing thoracotomy versus thoracoscopy. Unlike other postsurgical pain conditions, none of the preoperative psychosocial measurements were associated with chronic pain after thoracic surgery.

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Section: Discussionmentioning

confidence: 99%

A Prospective Study of Chronic Pain after Thoracic Surgery

et al. 2017

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“…The control and management of pain are of prime importance in the case of severe pain, elderly patients, and coexist respiratory failure. In various studies, the efficacy of invasive treatments such as thoracic epidural analgesia was surveyed ( 10 ). The approaches of modern anesthesiology have been extended to the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Continuous Thoracic Epidural Analgesia with Bupivacaine Versus Bupivacaine and Dexmedetomidine for Pain Control in Patients with Multiple Rib Fractures

et al. 2018

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BackgroundThe control of pain in traumatic patients with chest injury leading to rib fracture is one of the primary goals in traumatic patients. The efficacy of the thoracic epidural approach in comparison with other approaches for relieving post-thoracotomy pain is unknown. The goal of the present study was to compare thoracic epidural analgesia with bupivacaine alone and in combination with dexmedetomidine in patients with multiple rib fractures. Methods64 traumatic patients with multiple rib fractures were selected and randomly assigned to two similar groups. For pain relief, a thoracic epidural catheter was inserted to infuse bupivacaine alone or the combination of bupivacaine and dexmedetomidine. Then, we recorded and analyzed pain scores and ABG changes.ResultsBased on the results, the two approaches could result in proper analgesia, but analgesia with the combination of bupivacaine and dexmedetomidine was significantly improved compared to bupivacaine alone (P < 0.05). In addition, ABG of patients significantly changed when the combination of bupivacaine and dexmedetomidine was used within 2 to 4 days (P < 0.05).ConclusionsThe results of the present study showed that epidural infusion of a combination of bupivacaine and dexmedetomidine could provide better control of rib fracture pain in traumatic patients, and is a proper alternative for bupivacaine alone.

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“…[ 7 ] It has the advantages of unilateral sympathetic blockade and has fewer hemodynamic variations. [ 8 ] PVB is an appealing alternative to neuraxial blockade where the latter is contraindicated. [ 9 ] Although it shows good analgesic properties, it has not been used extensively due to the requirement of good skill.…”

Section: Introductionmentioning

confidence: 99%

Comparison of paravertebral block with conventional spinal anesthesia in patients undergoing unilateral inguinal hernia repair

Rani

Vaishnavi

et al. 2020

Anesth Essays Res

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Context: Although spinal anesthesia (also known as subarachnoid block [SAB]) is used widely for inguinal hernia repair, the paravertebral block (PVB) that produces unilateral, segmental analgesia is used with a high success rate in inguinal hernia repair. Aims: The aim of the study was to compare SAB and PVB in inguinal hernia repair, in terms of the duration of postoperative analgesia and adverse events. Settings and Design: This was a prospective, randomized, controlled double-blind study. Methods: This study was done on 60 male patients of American Society of Anesthesiology (ASA) I and II. Patients were categorized into 30 in each group, either to receive PVB block at two levels T10 and L1 using 15 mL and 5 mL of 0.5% bupivacaine and 1 μg.kg −1 of buprenorphine or SAB with 12.5 mg of 0.5% hyperbaric bupivacaine injected intrathecally. Statistical Analysis Used: SPSS 18.0 and R version 3.2.2 were used for analyzing the data. Categorical measurements were presented in number (%) and analyzed using Chi-square/Fischer's exact test. Continuous measurements were analyzed using Student's t -test. Results: Age, weight, height, and ASA status were comparable in both the groups. In the PVB group, eight patients had failure of block. Hemodynamic responses, time to first analgesia and ambulation, time required to perform the block, Bromage score, satisfaction score, failure rate, and intra- and postoperative drugs used showed a statistically significant difference between the groups ( P < 0.001). Conclusion: PVB is not a sole anesthetic technique due to a higher failure rate and increased intraoperative fentanyl requirement but has advantages such as prolonged analgesia, stable hemodynamics, and early ambulation.

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

Cited by 12 publications

References 23 publications

A Prospective Study of Chronic Pain after Thoracic Surgery

A Prospective Study of Chronic Pain after Thoracic Surgery

A Comparison of Continuous Thoracic Epidural Analgesia with Bupivacaine Versus Bupivacaine and Dexmedetomidine for Pain Control in Patients with Multiple Rib Fractures

Comparison of paravertebral block with conventional spinal anesthesia in patients undergoing unilateral inguinal hernia repair

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