Influence of Regional Anesthesia on the Rate of Chronic Postthoracotomy Pain Syndrome in Lung Cancer Patients

Хороненко, В.Э.; Baskakov, Danil; Léone, Marc; Malanova, A.S.; Ryabov, А. B.; Пикин, О. В.; Головащенко, М. П.

doi:10.5761/atcs.oa.18-00044

Cited by 20 publications

(8 citation statements)

References 29 publications

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“…( 22) Study on thoracotomy suggested that paravertebral block could not reduce chronic postoperative pain. (23) Our study found that paravertebral block did not affect the incidence, severity and characteristics of pain, but reduced the incidence of hypoesthesia, numbness and sleep disorder three months after hepatectomy. Possible explanations might be reduced central sensitization due to nerve block, which should be applied as early as possible.…”

Section: Discussionmentioning

confidence: 42%

Effects of Intermittent Bolus Paravertebral Block On Analgesia and Recovery in Open Hepatectomy: A Retrospective, Cohort Study.

Wang

Cui

Zhang

et al. 2021

Preprint

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Background Experiences of paravertebral block use in hepatectomy were limited. We aimed to investigate the effects of intermittent bolus paravertebral block on analgesia and recovery in hepatectomy. Methods We selected patients receiving two types of analgesia programs, with matched age, sex and body mass index from a prospective perioperative analgesia and nerve block database: (1) PVB: intermittent bolus paravertebral block (0.5% ropivacaine 25ml before surgery plus 0.125ml•kg− 1 0.2% ropivacaine bolus per hour after surgery) and self-controlled intravenous bolus morphine pump till postoperative 48 hours; (2) control: self-controlled intravenous bolus morphine pump till postoperative 48 hours. The baseline, operation, and postoperative analgsia and recovery data were compared between groups. Results Thirty-eight patients in each group were included in the analysis. Intraoperatively, PVB group used less sevoflurane (difference − 0.1 (-0.2, 0.0) %, P = 0.019), and more ephedrine (U = 986, P = 0.004) and crystalloid (U = 936, P = 0.024) than control group. The mean arterial pressure in PVB group was lower than that in control group (difference − 4mmHg, 95%CI -8 ~ 0mmHg, P = 0.031) but similar to its baseline level (difference 2, 95%CI -1 ~ 5, P = 0.153). Postoperatively, PVB group had lower cumulative morphine consumption at postoperative 2 (U = 371.5, P < 0.001), 4 (U = 349.5, P < 0.001), 12 (U = 342.0, P < 0.001), 24 (U = 338.5, P < 0.001) and 48 (U = 392.5, P = 0.001) hour, lower pain numerical rating scale score at rest at postoperative 0 (U = 299.5, P < 0.001), 2 (U = 355.5, P < 0.001) and 4 (U = 332.0, P < 0.001) hour, and on movement at postoperative 0 (U = 269.5, P < 0.001), 2 (U = 405.0, P = 0.001), 4 (U = 382.5, P < 0.001) and 12 (U = 1179.5, P = 0.003) hour than control group. PVB group also had lower rescue analgesia rates (OR 0.29, 95%CI 0.08 ~ 1.00, P = 0.044), higher emergence satisfaction (5 (4, 5) vs 4 (4, 5), P = 0.018) and lower drowsiness score (0 (0,1) vs 1(0,1), P = 0.007) than control group. Three months postoperatively, PVB group had lower rates of hypoesthesia (OR 0.28 (0.11, 0.75), P = 0.009), numbness (OR 0.26 (0.07, 0.88), P = 0.024) and sleep disorder (OR 0.84 (0.73, 0.97), P = 0.025) than control group. Conclusions Intermittent bolus paravertebral block provided anesthetics- and opioids-sparing effects, and enhanced recovery both in hospital and after discharge in patients receiving hepatectomy.

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Section: Discussionmentioning

confidence: 42%

Effects of Intermittent Bolus Paravertebral Block On Analgesia and Recovery in Open Hepatectomy: A Retrospective, Cohort Study.

Wang

Cui

Zhang

et al. 2021

Preprint

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“…Необходимо отметить, что возникшие в послеоперационный период изменения функции внешнего дыхания способны сохраняться у пациентов в течение нескольких лет, что обусловливает высокий риск развития инфекционных бронхопульмональных осложнений не только на этапе госпитализации, но и в поздний послеоперационный период [16,17]. Использование высокой грудной эпидуральной блокады (согласно собственным данным и данным литературы) обеспечивает наиболее раннее и адекватное восстановление дыхательной функции в торакальной хирургии, тем самым снижая вероятность присоединения инфекционных бронхопульмональных осложнений [15,18].…”

Section: Discussionunclassified

Post-thoracotomy pain syndrome as a risk factor for the development of nosocomial pneumonia

Хороненко

Baskakov

Malanova

et al. 2019

Annals of Critical Care

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Background. Pain syndrome is the most common complication of thoracotomy. It is the main reason of discomfort in postoperative period and could impair respiratory function. The aim of the study. The aim of our study was to analyze the effect of PTPS on pulmonary function and postoperative pneumonia rate in patients underwent open surgery on the lung cancer. Methods. 300 patients were included in the study operated on in our clinic for lung cancer via thoracotomy approach. All patients were randomly assigned to 3 comparable groups according to the method of anesthesia: thoracic epidural analgesia (HEA), n = 100; paravertebral block (PVB), n = 100; intercostal block (IRB), n = 100. On the 3rd day after the operation, the intensity of the pain syndrome was evaluated by VAS and spirometry was performed. Results. Analysis of the intensity of postoperative pain syndrome showed the superiority of epidural analgesia over other techniques. In patients with pain syndrome with an intensity of more than 30 mm VAS, the FEV1, VC, and chest excursions were signifi cantly lower than in patients with pain up to 30 mm VAS. The development of pain syndrome of more than 70 mm of VAS led to a signifi cant deterioration in VC rate and chest excursion if compare to patients with AHD 31-70 mm of VAS, which increases the risk of infectious complications. Conclusion. An optimal antinociceptive protection in the perioperative period improves respiratory function and helps to reduce pulmonary complications rate. The method of choice in open thoracic surgery for lung cancer is a combined general anesthesia with a high thoracic epidural block.

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“…But, they have been found to prevent and reduce the incidence of CPSP following major open lung surgery. 14 Hence, TPVB is an alternative to TEA, and has been found to provide similar analgesia.…”

Section: Common Relevant Ra Technique Under Usg In Icu 1 Thoracic Paravertebral Block (Tpvb)mentioning

confidence: 98%

“…[10][11][12] Out of all the modifiable risk factors, perioperative RA improve patient's status and outcomes. 5,13,14 The mechanism for development of CPSP in ICU is because of peripheral and central sensitization that can occur after persistent acute pain or input of triggering factors.…”

Section: The Problem Of Chronic Post-icu Painmentioning

confidence: 99%

Role of regional analgesic techniques in ICU

Sahoo¹

2019

APIC

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Pain is a major problem in patients admitted in the Intensive Care Units (ICU). Untreated pain has significant impact on the outcome of these patients, especially surgical patients. There is enough evidence in the literature which has demonstrated that inadequately treated pain in ICU leads to prolonged ventilation, longer ICU stay, morbidity and other issues like development of post-traumatic stress disorder (PTSD) and chronic post-surgical pain (CPSP). Regional anesthesia and analgesia (RA) techniques like epidural analgesia, paravertebral blocks, and other peripheral nerve blocks (PNB) play a great role in providing significant pain relief, thus, limiting the use of opioids. They facilitate in earlier weaning from ventilation, reducing respiratory morbidity, and faster rehabilitation. These RA techniques are most useful in polytrauma patients, major thoracoabdominal and orthopedic surgeries, as many of them require post-surgical ICU care. However, these RA techniques are underutilised in many ICUs. Many a times, ICU physicians are not well versed with these RA techniques, and sometimes have fixed misconceptions with regards to these blocks. In this review, we will discuss on the need of these RA techniques and make a quick presentation on the technical aspect of frequently used blocks. The review will only focus on Ultrasound-guided regional analgesia (USRA) techniques as USG is commonly available in ICUs.Abbreviations: PTSD (Post-traumatic stress disorder), CPSP (Chronic post-surgical pain), RA (Regional anesthesia and analgesia), USRA Ultrasound-guided regional analgesia), PNB (Peripheral nerve block), IFPB (Interfascial plane blocks), ASRA (American Society of Regional Anesthesia and Pain Medicine) Citation: Sahoo RK, Nair AS, Badole UR, Kar R, Jadon A. Role of regional analgesic techniques in ICU. Anaesth Pain & Intensiv Care 2018;22 Suppl 1:S73-S82

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Influence of Regional Anesthesia on the Rate of Chronic Postthoracotomy Pain Syndrome in Lung Cancer Patients

Cited by 20 publications

References 29 publications

Effects of Intermittent Bolus Paravertebral Block On Analgesia and Recovery in Open Hepatectomy: A Retrospective, Cohort Study.

Effects of Intermittent Bolus Paravertebral Block On Analgesia and Recovery in Open Hepatectomy: A Retrospective, Cohort Study.

Post-thoracotomy pain syndrome as a risk factor for the development of nosocomial pneumonia

Role of regional analgesic techniques in ICU

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