Pain management within an enhanced recovery program after thoracic surgery

Thompson, Calvin; French, Daniel; Costache, I.

doi:10.21037/jtd.2018.09.112

Cited by 50 publications

(50 citation statements)

References 46 publications

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“…Moreover, the rate of single-day opioid usage in contrast to multiple days was significantly less in the ICC group, pointing at better overall pain control with only little benefit experienced with rescue medication. This finding is in accordance with various ERAS protocols and pain management regimens by trying to limit the use of opioids and their potential side effects [ 27 , 28 ]. With regard to the ongoing opioid crisis, ICCs have been shown to be an appropriate adjuvant therapy for postoperative pain management [ 16 , 17 ].…”

Section: Discussionsupporting

confidence: 84%

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Ponholzer

Maier

et al. 2021

JCM

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Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) affects patients’ recovery, postoperative complications, and length of stay (LOS). Despite its relevance, there are no guidelines on optimal perioperative pain management. This study aims to analyse the effects of an additional intercostal catheter (ICC) in comparison to a single shot intraoperative intercostal nerve block (SSINB). Methods: All patients receiving an anatomic VATS resection between June 2019 and May 2020 were analysed retrospectively. The ICC cohort included 51 patients, the SSINB cohort included 44 patients. Results: There was no difference in age, gender, comorbidities, or duration of surgery between cohorts. Pain scores on the first postoperative day, after chest drain removal, and highest pain score measured did not differ between groups. The overall amount of opioids (morphine equivalent: 3.034 mg vs. 7.727 mg; p = 0.002) as well as the duration of opioid usage (0.59 days vs. 1.25 days; p = 0.005) was significantly less in the ICC cohort. There was no difference in chest drain duration, postoperative complications, and postoperative LOS. Conclusions: Pain management with ICC reduces the amount of opioids and number of days with opioids patients require to achieve sufficient analgesia. In conclusion, ICC is an effective regional anaesthesia tool in postoperative pain management in minimally invasive thoracic surgery.

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Section: Discussionsupporting

confidence: 84%

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Ponholzer

Maier

et al. 2021

JCM

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“…These results could be taken into account for further research in order to evaluate SSTS prescription in ERAS protocols. [14]…”

Section: Discussionmentioning

confidence: 99%

Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study

et al. 2019

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Introduction: Sufentanil sublingual tablet system (SSTS) (Zalviso ® ) is a sublingual system for patient controlled analgesia, demonstrated to be an effective strategy for pain control after major abdominal and orthopedic surgery. We present a prospective observational study on the use of SSTS for the management of postoperative pain after thoracic surgery. The aim of this study was to assess the efficacy of Zalviso ® in reducing pain scores and increasing respiratory ability during postoperative period. Materials and Methods: There were about 40 patients underwent video assisted thoracoscopy were included in the study. All the enrolled patients signed the informed consent were educated to the use of the device. Pain numeric rating scale values (NRS) were recorded at awakening from anesthesia (T0) and during the next hours, both at rest and with cough. We evaluate the time to obtain a mean NRS value ≤3 and difference in pain scores between first and subsequent measurements as the primary outcomes. The ability to use incentive spirometer and eventual drug adverse effect were evaluated as secondary outcomes. Results: All patients in recovery room experienced moderate to severe pain. Pain score at rest and coughing decreased to a mean NRS value ≤3 (mild pain) respectively after 2 and 6 hours and the pain score difference continued to increase significantly after repeated measurements. 67.5% of patients resumed the original spirometric ability in pod 1; 9.5% in pod 2; 12% in pod 3. Only three patients out of forty (7,5%) experienced nausea; one patient (2,5%) had a vomiting episode. Conclusion: Our study showed SSTS as an effective option for postoperative pain management in thoracic surgery, improving pain scores and respiratory ability.

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“…21 the challenge is to optimize pain control earlier in the postoperative recovery phase to enable ambulation and a better recovery profile, as well as to minimize the risk of development of chronic persistent postoperative pain. 13 We believe that this study is a step in the way to find the ideal, safest, and most efficient method to deliver local anesthetic to the PVS. We encourage further studies in this field because efficient postoperative pain management is the cornerstone of enhanced recovery after surgery programs.…”

Section: Discussionmentioning

confidence: 92%

“…Catheter techniques have the benefit of prolonging analgesia to improve patient mobilization and recovery. 13…”

Section: Discussionmentioning

confidence: 99%

Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

Hegazy

Awad

Abdellatif

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Paravertebral block can be performed with the aid of surgical landmarks, ultrasound, or a thoracoscope. This study was designed to compare ultrasound-guided paravertebral block with the thoracoscopic technique. Methods This prospective randomized comparative study included 40 adults scheduled for elective thoracic surgery. Study participants were randomized to an ultrasound group or a thoracoscope group. A catheter for paravertebral block was inserted prior to thoracotomy with real-time ultrasound visualization in the ultrasound group, and under thoracoscopic guidance in the thoracoscope group. Total analgesic consumption, visual analogue pain score, technical difficulties, and complications were compared between the 2 groups. Results Total analgesic consumption in the first 24 hours was less in the ultrasound group than in the thoracoscope group (rescue intravenous fentanyl 121.25 ± 64.01 µg in the ultrasound group vs. 178.75 ± 91.36 µg in the thoracoscope group; p = 0.027). Total paravertebral bupivacaine consumption was 376.00 ± 33.779 mg in the ultrasound group and 471.50 ± 64.341 mg in the thoracoscope group ( p < 0.001). Technical difficulties and complications in terms of time consumed during the maneuver, more than one needle pass, and pleural puncture were significantly lower in the ultrasound group than in the thoracoscope group. Conclusion Ultrasound-guided paravertebral catheter insertion is more effective, technically easier, and safer than the thoracoscope-assisted technique.

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Pain management within an enhanced recovery program after thoracic surgery

Cited by 50 publications

References 46 publications

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study

Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

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Pain management within an enhanced recovery program after thoracic surgery

Cited by 50 publications

References 46 publications

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Sufentanil sublingual tablet system (Zalviso®) as an effective analgesic option after thoracic surgery: An observational study

Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

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Product

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Sufentanil sublingual tablet system (Zalviso^®) as an effective analgesic option after thoracic surgery: An observational study