Pain Management After Thoracic Surgery

Pennefather, Stephen H.; Quarterman, Clare; Klinger, Rebecca Y.; Kanellakos, George W.

doi:10.1007/978-3-030-00859-8_59

Cited by 2 publications

(2 citation statements)

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“…An increase in the dose of bupivacaine reduces the intensity of postoperative pain, reduces the opiate administration time to first analgesic demand, and decreases the incidence of nausea and vomiting (8). Intrathecal injection of alpha 2 agonists, such as dexmedetomidine, as adjuncts to topical anesthetics, can enhance the effects of anesthetic drugs and reduce their demand (5, 9-11). Dexmedetomidine as an adjunct directly increases the block time through the direct modulating of receptors on motor neurons and posterior horn sensory neurons of the spinal cord or their synapses (12, 13).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial

et al. 2019

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BackgroundEpidural block approach and drugs are common options for improving the sensory and motor block duration and postoperative pain management.ObjectivesThe study aimed to compare the analgesic effects of dexmedetomidine and morphine as adjuvants to bupivacaine for epidural anesthesia in leg fracture surgery.MethodsThis prospective clinical trial was conducted on patients (n = 80, age range: 18 - 60 years) categorized as ASA class I or II. After a clinical examination, the patients were allocated to receive either lumbar epidural bupivacaine + morphine (BM) (12 mL bupivacaine 0.5% + morphine 2 mg) or bupivacaine + dexmedetomidine (BD) (12 mL bupivacaine 0.5% + dexmedetomidine 1 µg/kg). After drug administration, the sensory block level was assessed at 2-min intervals using the Cold Swab method until it reached the T12 level. At the T12 level of sensory block, the surgery began when motor block reached grade 3 of the modified Bromage scale.ResultsThe BD group had a significantly shorter time to reach the sensory and motor block than the BM group (P < 0.001). The duration of sensory and motor block was significantly longer in the group BD than in the BM group (P < 0.001). Moreover, the BD group showed lower VAS scores (P < 0.0001) and longer time to first analgesia demand than the BM group.ConclusionsCombined bupivacaine + dexmedetomidine prolongs the sensory and motor block duration and controls postoperative pain more effectively, indicating that it is an appropriate combination for epidural anesthesia.

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Section: Introductionmentioning

confidence: 99%

Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial

et al. 2019

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“…Ноцицептивні вісцеральні аференти виникають із блукаючого нерва, отримуючи ноцицептивні імпульси від легені, середостіння та середостінної плеври, тоді як діафрагмальний нерв отримує імпульси від діафрагмальної плеври. За умови подразнення діафрагмального нерву, пацієнти скаржаться на біль, що іррадіює в плечі та спину і тому цей біль не може бути знеболеним за допомогою епідурального катетера, що встановлюється на рівні Th-5 -Th-6 [6,7].…”

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Choice of the Optimal Method of Perioperative Anesthesia at Thoracotomia

Славута¹,

Дубров²,

Понятовський³

et al. 2021

Pain Anaesth Int Care

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Introduction. Lung cancer occupy an advanced place among malignant neoplasms. It is more common in men aged 30 to 74 years. Almost all lung cancer patients need surgical treatment. Pulmonary dysfunction is caused by impaired evacuation of bronchial secretions, and the diaphragm dysfunction due to the pain. Postoperative pain is one of the main reasons for the development of complications. There are many methods of postoperative pain control, but the search for a better method is still ongoing.Objective. Improve results of perioperative analgesia in patients undergoing thoracotomy by choosing the optimal method of analgesia.Маterials and methods. 45 patients with lung cancer who underwent thoracotomy. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision, 50 mg of dexketoprofen intravenously and epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative period - 2 mg / ml (3-7 ml / h) of ropivacaine. Group B: epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative - 2 mg / ml (3-7 ml / h) ropivacaine. Group C: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision and of 50 mg of dexketoprofen intravenously. Group D: Without pre-emptive analgesia and epidural analgesia. The severity of the pain syndrome was assessed using a numerical rating scale (NRS) after 3, 6, 12, 24 and 32 hours.Results and discussion. No statistically significant differences were observed in the subgroups by age, body weight, duration of surgery and blood loss (p> 0.05). Patients in group A did not require additional morphine analgesia and reported lower pain intensity using NRS. After 32 hours, the data were significantly different from groups B, C, and D (p <0.05). There was no significant difference between groups B and C in the assessment of the NRS (p <0.05), but in the group C only one patient required additional morphine analgesia.Conclusion. The effectiveness of the combination of pre-emptive analgesia and epidural analgesia indicates sufficient level of analgesia in patients after lung surgery. A multimodal approach to perioperative analgesia for patients undergoing thoracic surgery without epidural analgesia reduces opioid use compared to epidural analgesia alone.

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Pain Management After Thoracic Surgery

Cited by 2 publications

References 352 publications

Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial

Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial

Choice of the Optimal Method of Perioperative Anesthesia at Thoracotomia

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