Comparison of different methods of postoperative analgesia after thoracotomy—a randomized controlled trial

Białka, Szymon; Copik, Maja; Daszkiewicz, Andrzej; Rivas, Eva; Ruetzler, Kurt; Szarpak, Łukasz; Misiołek, Hanna

doi:10.21037/jtd.2018.07.88

Cited by 24 publications

(27 citation statements)

References 45 publications

(58 reference statements)

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“…It has previously been reported that poorly controlled acute postoperative pain is a risk factor associated with respiratory complications [27], and that postoperative pain may lead to the development of atelectasis because it can interfere with the normal activity of respiratory muscles and forced respiratory effort [28]. On the other hand, other studies have shown that epidural analgesia provides better postoperative pain control than systemic opioid administration in abdominal or open thoracotomy surgery [29,30]. In the present study, epidural patient-controlled analgesia was used less commonly in patients reversed with sugammadex than those reversed with pyridostigmine.…”

Section: Discussionmentioning

confidence: 99%

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Song

Yoo

et al. 2020

Preprint

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Background: Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce postoperative complications and thereby reduce hospital length of stay (LOS) after lung surgery. Methods: We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group.The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for prolonged LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results: Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95) and resulted in a shorter LOS in patients without a prolonged LOS). Among patients undergoing open lung lobectomy for lung cancer, compared to pyridostigmine, neuromuscular reversal with sugammadex resulted in a short hospital LOS and a lower incidence of postoperative complications, but showed a similar mortality. Conclusions: Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population.Trial registration: This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

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Section: Discussionmentioning

confidence: 99%

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Song

Yoo

et al. 2020

Preprint

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“…In thoracic surgery, intravenous patient controlled analgesia (PCA), thoracic epidural and continuous paravertebral block are strictly recommended by international guidelines. [45] However, these regional techniques are invasive, riskful,[6] requiring skilled operators and a challenging postoperative management. Moreover, continuous regional techniques may be at risk of failure, due to catheter displacement or infusion pump malfunction.…”

Section: Introductionmentioning

confidence: 99%

Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study

et al. 2019

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Introduction: Sufentanil sublingual tablet system (SSTS) (Zalviso ® ) is a sublingual system for patient controlled analgesia, demonstrated to be an effective strategy for pain control after major abdominal and orthopedic surgery. We present a prospective observational study on the use of SSTS for the management of postoperative pain after thoracic surgery. The aim of this study was to assess the efficacy of Zalviso ® in reducing pain scores and increasing respiratory ability during postoperative period. Materials and Methods: There were about 40 patients underwent video assisted thoracoscopy were included in the study. All the enrolled patients signed the informed consent were educated to the use of the device. Pain numeric rating scale values (NRS) were recorded at awakening from anesthesia (T0) and during the next hours, both at rest and with cough. We evaluate the time to obtain a mean NRS value ≤3 and difference in pain scores between first and subsequent measurements as the primary outcomes. The ability to use incentive spirometer and eventual drug adverse effect were evaluated as secondary outcomes. Results: All patients in recovery room experienced moderate to severe pain. Pain score at rest and coughing decreased to a mean NRS value ≤3 (mild pain) respectively after 2 and 6 hours and the pain score difference continued to increase significantly after repeated measurements. 67.5% of patients resumed the original spirometric ability in pod 1; 9.5% in pod 2; 12% in pod 3. Only three patients out of forty (7,5%) experienced nausea; one patient (2,5%) had a vomiting episode. Conclusion: Our study showed SSTS as an effective option for postoperative pain management in thoracic surgery, improving pain scores and respiratory ability.

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“…25 Although conflicting results existed in the literature, TEA proved its efficacy over conventional analgesia and other regional techniques. [1][2][3][6][7][8][9]26,27 Reducing the requirement for rescue analgesics, sustained mode of action and relatively low incidence of serious procedurerelated complications are the main advantages of TEA, which made it accepted as the gold standard method. 1,6,9 Along with these, TEA has superiority over conventional analgesia through preserving cardiopulmonary functions, diminishing stress response, facilitating the recovery of gastrointestinal motility and improving immune function.…”

Section: Discussionmentioning

confidence: 99%

Timelog-Based Approach to Early Post-Thoracotomy Pain in Lung Cancer Surgery

Omaygenç¹,

Çıtak²,

İşgörücü³

et al. 2019

Turkiye Klinikleri J Anest Reanim

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ostoperative pain is a determinant of quality of life and complication occurrence after thoracotomy. 1-3 Impaired chest wall integrity, rib fractures, intercostal neural damage and alteration of nociception are the main factors determining the intensity of pain. 1,2,4 Systemic analgesia and regional analgesia techniques can be utilized separately or as a combination treatment to provide adequate pain relief. Regional analgesia was frequently used at the last 20 years since its safety and efficacy was 39 Timelog-Based Approach to Early Post-Thoracotomy Pain in Lung Cancer Surgery A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Postoperative pain is a major concern about thoracotomy and acts a determinant of quality of life and complication occurrence. Here we sought to disctinctively assess the predictors of significant pain in the 1 st , 6 th , and 12 hours of elective lung cancer surgery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Seventy American Society of Anesthesiologists (ASA) 1-3 patients who were performed posterolateral thoracotomy by the same surgical team were retrospectively recruited. Perception of pain was quantified by Visual Analogue Scale (VAS) and VAS scores of 1 st , 6 th and 12 th hours were recorded and a score of four or higher was identified as significant pain. Postoperative analgesia was provided either by thoracic epidural analgesia (TEA) with 0.1% bupivacaine or pethidine-based intravenous analgesia (IVA) in our sample population. R Re es su ul lt ts s: : Regarding demographic characteristics, there were almost no significant differences among groups with and without significant pain (Group Significant Pain, SP, and Group Tolerable Pain, TP; respectively) at the first 12 hours. Exceptions were the presence of higher rates of iatrogenic rib fracture (p=0.02) and operation related complications (p=0.046) in Group SP at 1 st and 6 th hours respectively. The frequency of patients treated with IVA was significantly higher in SP group at 1 st and 6 th hours but not at 12 th hour. C Co on nc cl lu us si io on n: : Type of analgesia was solely detected to be a persistent determinant of significant pain after lung cancer surgery. However, this was valid for only the first six hours.K Ke ey yw wo or rd ds s: : Analgesia, epidural; pain measurement; thoracotomy Ö ÖZ ZE ET T A Am ma aç ç: : Postoperatif ağrı torakotomiye ilişkin temel bir sorundur; ve sadece yaşam kalitesinde değil komplikasyon görülme sıklığında da belirleyici rol oynar. Bu çalışmada elektif akciğer kanser cerrahisi sonrası 1,6 ve 12. saatlerde kaydadeğer ağrıyı predikte eden etkenlerin birbirinden ayrı olarak tespit edilmesi hedeflenmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Aynı cerrahi ekip tarafından posterolateral torakotomi ile opere edilen 70 Amerikan Anesteziyoloji Derneği (ASA) 1-3 hastanın verileri retrospektif olarak incelendi. Vizüel Analog Skalası (VAS) ile sayısallaştırılan ağrı algısına dair skorların 1, 6 ve 12. saatlerdeki değerleri kaydedildi ve dört ve üzeri değerler ...

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Comparison of different methods of postoperative analgesia after thoracotomy—a randomized controlled trial

Cited by 24 publications

References 45 publications

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study

Timelog-Based Approach to Early Post-Thoracotomy Pain in Lung Cancer Surgery

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Comparison of different methods of postoperative analgesia after thoracotomy—a randomized controlled trial

Cited by 24 publications

References 45 publications

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

Sufentanil sublingual tablet system (Zalviso®) as an effective analgesic option after thoracic surgery: An observational study

Timelog-Based Approach to Early Post-Thoracotomy Pain in Lung Cancer Surgery

Contact Info

Product

Resources

About

Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study