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

Kotemane, Naren C; Niraj, G.; Vaja, Ricky

doi:10.1097/eja.0b013e32833d1259

Cited by 53 publications

(37 citation statements)

References 8 publications

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“…By using INB, we found increased popularity for anesthetic methods without intubation among our patients undergoing thoracoscopic surgery. Thus, similar to the experience in the United Kingdom, 25 use of TEA rapidly declined and is no longer regarded as the gold standard for acute pain management after thoracic surgery. 26 , 27 …”

Section: Discussionmentioning

confidence: 96%

Nonintubated Thoracoscopic Lobectomy for Lung Cancer Using Epidural Anesthesia and Intercostal Blockade

et al. 2015

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Intubated general anesthesia with single-lung ventilation has been considered mandatory for thoracoscopic lobectomy for nonsmall cell lung cancer. Few reports of thoracoscopic lobectomy without tracheal intubation are published, using either thoracic epidural anesthesia (TEA) or intercostal blockade. The comparisons of perioperative outcomes of nonintubated thoracoscopic lobectomy using epidural anesthesia and intercostal blockade are not reported previously.From September 2009 to August 2014, a total of 238 patients with lung cancer who underwent nonintubated thoracoscopic lobectomy were recruited from our prospectively maintained database of all patients undergoing nonintubated thoracoscopic surgery using TEA or intercostal blockade. A multiple regression analysis, adjusting for preoperative variables, was performed to compare the perioperative outcomes of the 2 anesthesia methods.Overall, 130 patients underwent nonintubated thoracoscopic lobectomy using epidural anesthesia whereas 108 had intercostal blockade. The 2 groups were similar in demographic data, except for sex, preoperative lung function, physical status classification, and history of smoking. After adjustment for the preoperative variables, nonintubated thoracoscopic lobectomy using intercostal blockade was associated with shorter durations of anesthetic induction and surgery (P < 0.001). Furthermore, hemodynamics were more stable with less use of vasoactive drugs (odds ratio: 0.53; 95% confidence interval [CI], 0.27 to 1.04; P = 0.064) and less blood loss (mean difference: −55.2 mL; 95% CI, −93 to −17.3; P = 0.004). Postoperatively, the 2 groups had comparable incidences of complications. Patients in the intercostal blockade group had a shorter average duration of chest tube drainage (P = 0.064) but a similar average length of hospital stay (P = 0.569). Conversion to tracheal intubation was required in 13 patients (5.5%), and no in-hospital mortality occurred in either group.Nonintubated thoracoscopic lobectomy using either epidural anesthesia or intercostal blockade is feasible and safe. Intercostal blockade is a simpler alternative to epidural anesthesia for nonintubated thoracoscopic lobectomy in selected patients with lung cancer.

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Section: Discussionmentioning

confidence: 96%

Nonintubated Thoracoscopic Lobectomy for Lung Cancer Using Epidural Anesthesia and Intercostal Blockade

et al. 2015

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“…For an adequate postoperative pain management, it needs to be associated with an opioid-based PCA, as commonly done in UK (52). Alternatively, a longer analgesic coverage can be obtained with the continuous TPVB, i.e., the infusion of local anesthetics via a catheter placed in the paravertebral space (53).…”

Section: Thoracic Paravertebral Block (Tpvb)mentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

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“…In 2010, anaesthetists working in thoracic surgery centres in the UK were surveyed to see what analgesic technique was their first choice for various types of thoracic surgery. Half of the anaesthetists preferred paravertebral blocks with patient‐controlled analgesia for video‐assisted thoracoscopic lobectomy, whereas one‐third preferred patient‐controlled analgesia alone and only one‐tenth preferred epidurals . Patients undergoing open lung resection were grouped with patients having pleural decortication, making it difficult to determine preferred practice for open lung resection alone.…”

Section: Gold‐standard Regional Techniquesmentioning

confidence: 99%

Has analgesia changed for lung resection surgery?

Short

Kamalanathan²

2018

Anaesthesia

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

Abstract: The present survey demonstrates the increasing use of paravertebral block as an alternate regional anaesthetic technique to epidural analgesia after major thoracic surgery in the United Kingdom.

Cited by 53 publications

References 8 publications

Nonintubated Thoracoscopic Lobectomy for Lung Cancer Using Epidural Anesthesia and Intercostal Blockade

Nonintubated Thoracoscopic Lobectomy for Lung Cancer Using Epidural Anesthesia and Intercostal Blockade

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Has analgesia changed for lung resection surgery?

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