Pain Management in an Enhanced Recovery Pathway After Thoracic Surgical Procedures

Mehran, Reza J.; Martin, Linda W.; Baker, Carla M.; Mena, Gabriel E.; Rice, David C.

doi:10.1016/j.athoracsur.2016.05.050

Cited by 32 publications

(28 citation statements)

References 3 publications

(4 reference statements)

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“…Both the single-shot technique and the continuous infusion are possible, but only the latter seems effective after thoracic surgery (62). Other successful strategies contemplate the use of liposomal formulations (63,64). The continuous infusion of local anesthetic in the intercostal space provides adequate pain relief, comparable to TEA, until the 5th postoperative days after thoracotomy (65).…”

Section: Intercostal Nerve Block (Icnb)mentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

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Section: Intercostal Nerve Block (Icnb)mentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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“…(1). Consequently, patients, out for fear, tend to avoid exercising and coughing, as well as show a tendency to breath in a shallow and rapid manner, resulting in increased muscle contraction or tension that leads to reduced overall vital capacity (4,6). Hence, reducing fear of coughing and deep breathing is important for lung function recovery after pulmonary resection.…”

Section: Discussionmentioning

confidence: 99%

“…However, these methods involve continuous injection of narcotics, increasing the risk of developing side effects, including nausea, vomiting, dizziness, constipation, urinary retention, and other systemic-related side effects. To mitigate these side effects, techniques using a catheter, such as continuousslow infusion of local anesthetics into the paravertebral or direct wound space, have recently been established (3)(4)(5). This paravertebral technique, according to Raveglia and colleagues (6), has superior results compared with the PCA methods in thoracotomy patients; however, it has not been fully evaluated with respect to VATS.…”

Section: Original Articlementioning

confidence: 99%

Intramuscular stimulation as a novel alternative method of pain management after thoracic surgery

Moon¹,

Park²,

Kang³

et al. 2019

J. Thorac. Dis

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Background: The purpose of this study was to determine whether electrical twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative to intravenous patient-controlled analgesia (IV-PCA) for postoperative pain management in pneumothorax patients undergoing single-port video-assisted thoracoscopic surgery (VATS). Methods: This preliminary prospective randomized study was conducted between March 2017 and July 2017. A total of 26 patients undergoing single-port VATS were randomly assigned to two groups: the ETOIMS group (n=12), which received intramuscular stimulation prior to chest tube insertion toward the end of procedure, and the IV-PCA group (n=14), which received continuous infusion of fentanyl with a basal rate of 10 μg/mL/h. To measure postoperative pain, visual analogue scale (VAS; range, 0-10) was used as the primary endpoint. Results: Baseline characteristics were not different between the two groups. According to the linear mixed model, there was statistical difference in the serial VAS score between the two groups (P=0.007). The ETOIMS group showed a significantly lower VAS score compared with the IV-PCA group, especially at postoperatively hour 8, day 1, and day 2. Conclusions: We showed that ETOIMS may be a safe, effective, and simple alternative for pain management after single-port VATS.Moon et al. IMS after thoracic surgery (Medical Illustrator) for his help with the illustrations. FootnoteConflicts of Interest: The authors have no conflicts of interest to declare.

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“…In light of this, adequate post-thoracic surgery pain management becomes the main care element for patients in the postoperative period. Effective pain relief using holistic pain assessment and multidimensional pain management based on cutting-edge evidence aims at facilitating recovery and early ambulation in order to improve respiratory function and decrease post-operative complications after thoracic surgery (Mehran et al 2016;Montgomery & McNamara 2016).…”

Section: Introductionmentioning

confidence: 99%

Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital

Odejobi

Maneewat

Chittithavorn

2019

International Nursing Review

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Aim The overarching aim of this study was to investigate the effects of a nurse‐led pain management programme on pain intensity, side effects of treatment, shoulder range of motion and length of stay after thoracic surgery. Background Post‐thoracic surgical pain is a major source of stress and distress for patients. It has profound effects ranging from increased risks in developing chronic post‐thoracic surgery pain to an increased length of stay after surgery. The post‐thoracic surgical pain management in the Nigerian context is based on the traditional approach that is dependent on the attending medical and nursing staff. Methods The study was a quasi‐experimental design (two‐group post‐test only). The study was conducted in a Nigerian hospital. Forty‐two patients were recruited and consecutively assigned into either the usual pain management group or the intervention group after they had met the inclusion criteria. Data were collected utilizing the following: (1) the modified McGill Pain Questionnaire; (2) a Numeric Rating Scale; (3) the documentation form for thoracic surgery pain management outcomes and (4) a goniometer. Results The findings indicated that pain intensity, nausea and drowsiness were significantly reduced among the patients in the experimental group than the control group, while the duration of stay after surgery and the shoulder range of motion were not different between the groups. Conclusion This study's results suggest that the intervention in question for patients undergoing thoracic surgery had a positive effect on reducing pain intensity, nausea and drowsiness but not the shoulder range of motion and length of stay after surgery. Implications for nursing policy Nursing policymakers may need to give a serious consideration to the revision of policies related to the nursing education curriculum as well as the in‐service training curriculum regarding pain management by nurses especially after surgery. Likewise, future research on other populations employing an improved methodology as well as utilizing up‐to‐date evidence by nurses across different hospitals may be necessary.

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Pain Management in an Enhanced Recovery Pathway After Thoracic Surgical Procedures

Cited by 32 publications

References 3 publications

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Intramuscular stimulation as a novel alternative method of pain management after thoracic surgery

Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital

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