Effects of the prolonged thoracic epidural analgesia on ventilation function and complication rate after the lung cancer surgery

Abstract

Thoracic epidural analgesia has been considered to have a good anesthetic efficacy and to decrease the postoperative complication rate, while its effect upon the ventilation function is still the topic of many clinical studies. The aim of this study was to evaluate the course of early postoperative period using thoracic epidural analgesia. Material and methods. A total of 453 patients undergoing the operation due to the non–small cell carcinoma were selected and examined. Their postoperative complications and mortality rate were evaluated. In 79 patients, arterial oxygen saturation (SaO2), forced vital capacity, forced expiratory volume in the first second, and the efficacy of analgesia were analyzed within the first 7 days after the operation. These patients were divided into subgroups according to the type of the operation – lobectomy or pneumonectomy – and the type of analgesia – thoracic epidural analgesia or opiates administered intramuscularly (control group). Results. A better statistically significant efficacy of analgesia was observed in thoracic epidural analgesia group than in the control group (visual analog pain scale score 2.5 versus 5.3, P<0.01). There was also a statistically significant lower incidence of postoperative complications (20.5% versus 38.8%, respectively). Thoracic epidural analgesia is a factor decreasing the relative risk of complications (RR=0.53, 95% CI 0.28–0.99, P=0.0233). In the lobectomy group, 24 hours after the surgery, forced vital capacity was 61±12% in the group receiving thoracic epidural analgesia and 45±13% in the control group (P=0.0152); forced expiratory volume in the first second was 56±17% and 41±11%, respectively (P=0.0308). In the pneumonectomy group, 24 hours after the surgery, forced vital capacity was 47±16% in the group receiving thoracic epidural analgesia, 35±8% in the control group (P=0.080). Forced expiratory volume in the first second was 47±15% and 36±7%, respectively (P=0.0449). Conclusion. We conclude that analgesia with intramuscularly administered opioids provides unsatisfactory analgesia, especially in the first days after the operation. Thoracic epidural analgesia is a safe method, which provides a better quality of life for the patient, decreases the postoperative complication rate, and improves the ventilation function after the lung operations.

Effect of ultrasound-guided pulsed radiofrequency on intercostal neuralgia after lung cancer surgery

“…However, patients who received this management also experience a variety of complications after LCS, such as ICN. [13][14][15][16][17][18][19][20] Non-invasive therapy, such as UGPRF has been reported to relieve various pain disorders. However, very few evidence regarding this issue is available.…”

“…Surgical resection remains the mainstay of effective treatment for such patients. However, patients who received this management also experience a variety of complications after LCS, such as ICN [13–20] …”

“…[9][10][11][12] However, lung cancer surgery (LCS) is traumatic and invasive procedures and often accompanies remarkable risks for postoperative lung complications, such as pneumonia, and intercostal neuralgia (ICN). [13][14][15][16][17][18][19][20] A variety of nonoperative managements are the first choice for ICN, which is responsible for relieving pain intensity of ICN in patients who received LCS, such as physical therapy, alternative medicine, acupuncture, and laser therapy. [21][22][23] Similar to other non-surgery modality, ultrasound-guided pulsed radiofrequency (UGPRF) is an alternative treatment when other conservative treatments are ineffective.…”

“…Surgery is recommended for lung cancer as one of the most effective management [9–12] . However, lung cancer surgery (LCS) is traumatic and invasive procedures and often accompanies remarkable risks for postoperative lung complications, such as pneumonia, and intercostal neuralgia (ICN) [13–20] …”

Association of thoracic epidural analgesia with risk of atrial arrhythmias after pulmonary resection: a retrospective cohort study

“…Kopeika et al [15] showed TEA provided superior postoperative pain control than intramuscular opioid administration after pulmonary resection, and found a tendency of less frequent postoperative atrial fibrillation among those who received TEA. Oka et al [17] compared TEA with bupivacaine and TEA with morphine for postoperative analgesia for pulmonary resection and found that occurrence of atrial fibrillation and supraventricular tachycardia within 3 days after surgery was less for TEA with bupivacaine.…”