Efficacy of Continuous Intercostal Bupivacaine for Pain Relief After Thoracotomy

Drydenf, C.M.; McMenemin, Ian M.; Duthie, D.J.R.

doi:10.1093/bja/70.5.508

Cited by 45 publications

(28 citation statements)

References 7 publications

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“…Da die kontinuierliche interkostale Wundinfusion eine geringere analgetische Potenz hat [7] und zudem bei langstreckiger interkostaler Lage von Kathetern Komplikationen bis hin zur Rippenosteomyelitis drohen [8], erfolgt der thorakale Einsatz der kontinuierlichen Wundinfusionskatheter zur perineuralen Lokalanästhetikaapplikation für einen kontinuierlichen paravertebralen Interkostalnervenblock (PVB [9,10,11,12] und Vorteile hinsichtlich der analgetischen Potenz gegenüber der alleinigen Opiatgabe demonstrieren [13].…”

Section: Kontinuierliche Wundinfusion Bei Thorakotomienunclassified

“…Bei Thorakotomien wurde in den zuvor zitierten Studien meistens Bupivacain 0,25% [11,12,15,17,18,19,21], gefolgt von Bupivacain 0,5% [9,10,16,20] eingesetzt. Regelhaft wurde vor der Dauerinfusion von (3)5-10 ml/h bzw.…”

Section: Wahl Und Dosierung Des Verwendeten Lokalanästhetikumsunclassified

“…Diese Hypothese wird durch die Vielzahl erfolgreich eingesetzter Kathetertypen zur kontinuierlichen PVB bestä-tigt: Meistens wurden Periduralkatheter (PDK) genutzt [9,10,11,14,15,18,20,21], wogegen einzelne einen 5f-MultiholeKatheter [16] oder sogar eine 8-F-RedonDrainage [14] zur Lokalanästhetikaappli-kation einsetzten. Bei zwei Studien fehlen nähere Angaben zum angewendeten Katheter [17,19].…”

Section: Introductionunclassified

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Kontinuierliche lokale Wundinfusion mit Lokalanästhetika

Mann

Hecker

et al. 2011

Chirurg

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Wound infusion with local anesthetics is a nearly 100 years old proven and secure analgesic method. Recently special wound infusion catheters have become available which can be placed intraoperatively into the wound under direct supervision of the surgeon to infuse local anesthetics and optimize postoperative analgesia. For thoracotomy this method was modified to improve its efficacy and the catheters are used to establish a continuous paravertebral intercostal nerve block (PVB). Many studies have confirmed the analgesic power of PVB which results in a pain reduction comparable to thoracic epidural analgesia (TEA) but without TEA-specific side-effects, in particular hypotension. The efficacy of continuous local wound infusion (CLWI) is less obvious for laparotomy. If fundamental preconditions for this loco-regional method are considered (indications, choice of catheter, local anesthetic dose) the laparotomy wound could also be suitable for the use of CLWI. According to the literature currently available CLWI is not associated with an increased risk of wound infections.

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Section: Kontinuierliche Wundinfusion Bei Thorakotomienunclassified

Section: Wahl Und Dosierung Des Verwendeten Lokalanästhetikumsunclassified

Section: Introductionunclassified

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Kontinuierliche lokale Wundinfusion mit Lokalanästhetika

Mann

Hecker

et al. 2011

Chirurg

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“…A systematic review of randomized trials evaluating regional techniques for acute post‐thoracotomy analgesia 1 concluded that when thoracic epidural analgesia with local anesthetics plus opioids or continuous paravertebral block with local anesthetics are not possible, or are contraindicated, intrathecal opioid or intercostal nerve block are recommended despite insufficient duration of analgesia, which requires the use of supplementary systemic analgesia. Other studies have shown that intercostal nerve blocks were associated with significantly reduced supplementary analgesic requirements when administered acutely as repeat blocks 2 and by continuous infusion, 3 but not as a single intraoperative block. Dräger et al 4 .…”

Section: Discussionmentioning

confidence: 99%

Peripheral Nerve Field Stimulation for Intractable Post‐Thoracotomy Scar Pain not Relieved by Conventional Treatment

et al. 2010

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Peripheral nerve field stimulation (PNFS) is being applied in individual cases where conventional treatments have failed to control pain localized to limited dermatomal distribution. We applied PNFS for unrelieved post-thoracotomy scar pain. Although spinal cord stimulation may have resulted in good coverage in the same dermatomal distribution, we chose the more peripheral approach to minimize the risk of complications, avoiding the potential neurologic sequelae associated with stimulation of the spinal cord. In summary, PNFS was effective in relieving post-thoractomy pain refractory to conventional pain management suggesting great potential of PNFS as a treatment option for chronic surgical-scar pain.

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“…Viele Autoren konnten durch die Anwendung von Intercostalblockaden eine deutliche Reduktion des Opioidverbrauches und auch signifikant erniedrigte Schmerzscores nachweisen [6,7]. Die potentielle Komplikation eines Pneumothorax erscheint hier vergleichsweise weniger bedrohlich, da nach thoraxchirurgischen Eingriffen meist eine Drainage im Pleuraspalt belassen wird.…”

Section: Intercostalblockadeunclassified

Schmerztherapie nach thoracoskopischen Eingriffen Haben Regionalanalgesieverfahren (Intercostalblockade oder Interpleuralanalgesie) Vorteile gegenüber einer intravenösen patientenkontrollierten Opioidanalgesie (PCA)?

Leger

Ohlmer

Scheiderer

et al. 1999

Chirurg

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Systemic opioids and thoracic epidural analgesia are common techniques used to provide post-operative analgesia following thoracoscopy (video-assisted thoracic surgery). The aim of the present prospective randomised study was to evaluate the efficacy of two less invasive analgesic techniques, intercostal blocks (ICB) and interpleural analgesia (IPA). After approval from the ethics committee and informed consent from the patients, 36 patients scheduled for thoracoscopic surgery were randomly assigned to a group for postoperative pain management: group ICB: intercostal blocks of the segments involved with 5 ml 0.5% bupivacaine at the end of surgery and 6 h later; group IPA: interpleural analgesia with 20 ml 0.25% bupivacaine applied every 4 h using a catheter placed during surgery near the apex of the interpleural space; control group: IV-opiod-PCA with piritamide. Patients in the ICB and IPA groups had access to pain relief by PCA with piritramide as well. Additional medication for all groups if the analgesia was insufficient consisted of metamizol. There were no significant differences in piritramide consumption between the two regional analgesia groups and the control group up to the 3rd and 7th postoperative day. Up to the 7th day piritramide consumption in group ICB was 78 mg, in group IPA 75 mg and 80 mg in the control group. Patients in group ICB showed significantly less pain at rest measured by the visual analogue scale (VAS) on the 1st postoperative day (U-test, P < 0.05), but otherwise there were no statistical differences regarding pain scores. Respiratory parameters such as forced vital capacity, forced expiratory volume, peak flow and the Tiffeneau test (FVC, FEV1, PF, FEV1/FVC) were reduced significantly after thoracoscopy and showed a slow recovery in all three groups without significant intergroup differences. Thoracoscopic surgery causes less and shorter lasting pain in comparison to thoracotomy. Nevertheless, effective pain management is necessary. We could not demonstrate a significant reduction in piritramide consumption for the techniques of regional analgesia tested here (ICB, IPA). We conclude that the use of these techniques is not complementary after thoracoscopy, since an opioid (PCA with piritramide) combined with a non-opioid (metamizol) resulted in satisfactory analgesia.

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Efficacy of Continuous Intercostal Bupivacaine for Pain Relief After Thoracotomy

Cited by 45 publications

References 7 publications

Kontinuierliche lokale Wundinfusion mit Lokalanästhetika

Kontinuierliche lokale Wundinfusion mit Lokalanästhetika

Peripheral Nerve Field Stimulation for Intractable Post‐Thoracotomy Scar Pain not Relieved by Conventional Treatment

Schmerztherapie nach thoracoskopischen Eingriffen Haben Regionalanalgesieverfahren (Intercostalblockade oder Interpleuralanalgesie) Vorteile gegenüber einer intravenösen patientenkontrollierten Opioidanalgesie (PCA)?

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