Post-thoracotomy analgesia

Mijatovic, Desimir; Bhalla, Tarun; Farid, Ibrahim

doi:10.4103/sja.sja_743_20

Cited by 10 publications

(10 citation statements)

References 88 publications

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“…However, even after minimally invasive thoracic operations, some patients suffer from chronic complaints, although they are less frequent and of lower intensity compared to thoracotomy [31]. Several anaesthesiological strategies to post-thoracotomy analgesia have been proposed to reduce the postoperative pain, such as thoracic epidural analgesia, intrathecal analgesia, paravertebral block, serratus anterior plane block, erector spinae block, intercostal nerve block, cryoablation, interpleural block, and interscalene block [32][33][34][35]. However, none of these techniques has offered a major significant relief of postoperative thoracic pain.…”

Section: Discussionmentioning

confidence: 99%

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

Leivaditis,

Grapatsas,

Ehle

et al. 2023

kitp

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Minimally invasive thoracic techniques often need to be converted to open thoracotomy. Thoracotomy is associated with severe postoperative pain in 50% of the patients, and this situation can be maintained for a prolonged period. Many efforts have been made to avoid this complication. We propose an easy and fast thoracotomy closure technique to avoid nerve entrapment at the time of chest closure suitable for cases of conversion to thoracotomy after a minimally invasive attempt. The proposed method effectively avoids interference with the intercostal nerve, which remains intact and restores the anatomy of the intercostal space. Efforts to decrease postoperative pain are vital. Thoracic surgeons are the principal health professionals able to deal with operative factors and postoperative pain management. We believe that the use of this easy and fast technique can facilitate excellent anatomic repositioning of the ribs alongside nerve sparing.

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Section: Discussionmentioning

confidence: 99%

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

Leivaditis,

Grapatsas,

Ehle

et al. 2023

kitp

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“…The active surface is directly applied to the intercostal such as Von Hippo Lindau disease, patients with a spine injury or coagulopathy). A variety of other multimodal regimens include erector spinae block and intercostal nerve block, systemic narcotics IV PCA provide shortterm analgesia, and the analgesic duration is typically insufficient for the entire recovery period [5,6,10].…”

Section: Mesenchymal Chondrosarcoma (Mcs)mentioning

confidence: 99%

“…However, chest wall surgery is frequently associated with severe, postoperative pain. Inadequate pain control in this period increases the risk of chronic post-thoracotomy pain syndrome and postoperative complications, decreases physical function, and worsens quality of life [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Intercostal Nerve Cryoneurolysis for Post-Thoracotomy Pain Control: A Case Discussion

Lu¹,

Miao²,

Sandra³

et al. 2022

Transl Perioper & Pain Med

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involvement and brachial plexus compression (Figure 1). A biopsy of the mass was reported as mesenchymal chondrosarcoma. After chemotherapy and radiation therapy, some of his symptoms, including right arm pain improved and the total tumor volume was slightly reduced. The patient was not taking pain medication at the time he was referred to our hospital for neuro/ thoracic surgical consultations for possible tumor resection.On admission, the patient stated he has been doing well, and denied shortness of breath, dyspnea on exertion, nausea, vomiting or worsening right arm sensory/motor dysfunction. His physical exam, laboratory studies, echocardiogram, electrocardiogram (EKG), chest X-ray (CXR) and pulmonary function testing (PFT), chest computed tomography (CT) scan and magnetic resonance imaging (MRI) were all stable. Surgical plans and proceduresTo start the case, the neurosurgeon placed the patient in the prone position to facilitate the dorsal approach to the right of T1-T4 spinous processes and corresponding vertebral bodies. At the level of T2 and T3, the transverse processes were transected, ribs disarticulated and the nerve roots ligated. The patient was then repositioned into the left decubitus position for the chest wall tumor resection including en bloc resection of a portion of T2 and T3 transverse processes (no reconstruction) (Figure 2).After the tumor was resected, the thoracic surgeons performed intercostal cryoneurolysis (IC) of the threelevel of ribs encompassing the surgical incision. The cryoprobe (cryoICE TM, Atricure Inc., Ohio) was placed into the thoracic cavity under direct visualization. It touched the membranous portion of the right fourth through sixth intercostal space, 4 cm away from the base of the spine to avoid iatrogenic injury to the sympathetic ganglia chain (Figure 3). Each nerve was frozen for 120 sec with a tip temperature between -50 °C to -70 °C. After the cryoneurolysis, the thoracic surgeon re-inspected the chest, established hemostasis

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“…The goal of this pain relief strategy is to improve analgesia without increasing the side effects compared with increased doses of single agents [ 7 ]. A multimodal analgesic protocol may contain both systemic analgesics and interventional techniques [ 8 ]. Typical elements of systemic analgesic options in pediatric patients undergoing the Ravitch procedure are usually opioids, non-steroidal anti-inflammatory drugs, paracetamol, diazepam, or gabapentin [ 9 , 10 ], while continuous epidural anesthesia appears to be one of the most commonly used interventional techniques [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study

Fenikowski

Tomaszek

2022

IJERPH

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Objective. To compare the efficacy of analgesia with intravenous infusion of morphine and thoracic epidural infusion of ropivacaine with fentanyl in pediatric patients after the Ravitch procedure. Methods. Postoperative analgesia was achieved by intravenous morphine infusion with a dose of 0.02–0.06 mg/kg per hour (intravenous group, n = 56) or thoracic epidural infusion of 0.2% ropivacaine and fentanyl 5 µg/mL with a flow rate of 0.1 mL/kg per hour (epidural group, n = 40). Furthermore, the multimodal pain management protocol included paracetamol, non-steroidal anti-inflammatory drugs, and metamizole as a rescue drug. The primary outcomes included pain scores (according to the Numerical Rating Scale, range 0–10), while the secondary outcomes included consumption of the rescue drug, anxiety, postoperative side effects, and patient satisfaction. The observation period lasted from postoperative day 0 to postoperative day 3. Results. Median average and maximal pain scores at rest, during deep breathing, and coughing were significantly lower in the intravenous group compared to the epidural group (p < 0.05). The effect size was medium (Cohen’s d ranged from 0.5 to 0.7). Patients receiving morphine required significantly lower numbers of metamizole doses than in the epidural group (median 1 vs. 3; p = 0.003; Cohen’s d = 0.6). Anxiety, postoperative side effects, and patient satisfaction were similar in both groups (p > 0.05). Conclusions. An intravenous infusion of morphine may offer better postoperative analgesia than a thoracic epidural infusion of ropivacaine with fentanyl.

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Post-thoracotomy analgesia

Cited by 10 publications

References 88 publications

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

Intraoperative Intercostal Nerve Cryoneurolysis for Post-Thoracotomy Pain Control: A Case Discussion

Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study

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