Postoperative analgesia after minimally invasive thoracoscopy: What should we do?

Neustein, Steven M.; McCormick, Patrick J.

doi:10.1007/s12630-011-9475-9

Cited by 17 publications

(8 citation statements)

References 16 publications

(28 reference statements)

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“…Insufficient analgesia may lead to adverse outcomes, such as extended hospital stay, and increase patient medical expenses. Although new surgical procedures, such as video-assisted thoracic surgery (VATS), have considerable advantages compared with traditional thoracotomy, 29% of the patients still undergo postoperative pain, which makes achieving postoperative analgesia challenging 2,3. Thoracic epidural analgesia is widely regarded as the gold standard for thoracic analgesia however with a certain failure rate, which also is associated with complications such as spinal hematoma and higher in-hospital mortality 4,5.…”

Section: Introductionmentioning

confidence: 99%

<p>Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial</p>

Chen¹,

Li²,

Yi-xiao³

et al. 2019

JPR

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Background Serratus anterior plane (SAP) block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve. Purpose Our study aimed to evaluate the effects of SAP block on postoperative pain after thoracoscopic surgery compared with local anesthetic (LA) infiltration. Patients and methods Forty adult patients undergoing video-assisted thoracic surgery were randomized to receive either SAP block (n=20) or LA infiltration of incision (n=20). The primary outcome was postoperative visual analog scale (VAS) score at the 2nd, 8th, 16th, 24th, and 48th hour after surgery. The secondary outcomes were the consumption of sufentanil at 8th, 16th, 24th hours postoperative. In addition, rescue analgesia, drug-related adverse effects after surgery was also analyzed. Results The SAP group showed lower VAS scores at the 2nd hour (at rest: SAP group 11 [8–13] vs LA group 28 [26–32], P =0.01; on coughing: 15 [13–18] vs 33 [26–38], P =0.01) and the 8th hour (at rest: 13 [12–18] vs 36 [32–46], P =0.01; on coughing: 19 [16–23] vs 42 [36–53], P =0.01) after surgery. Postoperative sufentanil consumption in the SAP group during 0–8 hrs was significantly lower compared with the LA group ( P <0.01). The use of rescue analgesia was also significantly lower in the SAP group ( P =0.02) during 0–12 hrs. Conclusion Compared to LA infiltration, ultrasound-guided SAP block may provide better pain relief as well as reduce opioid consumption after thoracoscopic surgery.

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Section: Introductionmentioning

confidence: 99%

<p>Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial</p>

Chen¹,

Li²,

Yi-xiao³

et al. 2019

JPR

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“…Torakoskopik girişimler sonrası postoperatif ağrı yönetimi için invaziv ve noninvaziv birçok yöntem uygulanmaktadır. Hangi yöntemin ideal olduğu konusunda tartışmalar sürse de, torakal veya lomber epidural kateter, tek doz spinal, paravertebral blok gibi invaziv rejyonel yöntemler hala yaygın olarak kullanılmaktadır [10][11][12] . Torasik epidural analjezi altın standart olarak kabul edilse de, kateter uygulamasının yanında, uygulanacak ilaç kombinasyonu ve infüzyonların ayarlanması da ayrı bir deneyim gerektirmektedir [13] .…”

Section: Is Intravenous Morphine Alone Sufficiently Effective For Posunclassified

Is Intravenous Morphine Alone Effective for Postoperative Analgesia in Bilateral, Single-port Video-Assisted Thoracoscopic Sympathectomy Performed in the Supine Position?

Uğuz¹,

Yapıcı²

2020

GKDA Derg

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INTRODUCTION: The method of operation carried out by clip application in the supine position and using a single port for thoracoscopic sympathectomy has been defined in recent years. Since lesser tissue damage occurs with this method, lower perception of pain may be anticipated. The aim of this study is to investigate whether intravenous morphine alone provides effective postoperative analgesia in thoracoscopic sympathectomy performed with clips method using a single port with the patient in the supine position. METHODS: Files of 28 patients who underwent thoracoscopic sympathectomy between January 2017-December 2019 were retrospectively screened. Intrathecal morphine was administered to a group at a dose of 0.6 mg in 3 mL physiologic saline (Group ITM, n=14), and the other group received IV morphine in the same doses only by the PCA method (Group PCA, n=14). Both groups received postoperative Patient Controlled Analgesia (PCA) with IV morphine, as 1 mg bolus within 30 min-lock- in time. VAS values and postoperative IV total morphine consumption were recorded at the time of extubation and at the 6th, 24th and 48th hours postoperatively RESULTS: Any statistically significant difference was not detected between patient groups as for demographic, and operative data. After extubation and at postoperative 6th hour, pain scores were statistically significantly lower in Group ITM than the Group PCA. Total IV morphine consumption at the postoperative 24th and 48th hours was statistically significant in the Group that did not receive ITM. In the postopoperative 48-hour follow-up, no VAS>4 value was observed in any one of the patients. Any intergroup difference was not detected as for length of hospital stay and complications associated with the method of analgesia used. DISCUSSION AND CONCLUSION: In conclusion, even though an adequate analgesia is ensured through ITM in thoracoscopic sympathectomy operations realized using clips method and a single port with the patient in the supine position,we think that admiinistration of morphine using IV PCA method may provide clinically acceptable analgesic efficacy, and a regional administration may not be required in patients who will be operated with this surgical technique.

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“…Its clinical application is much accredited for significant reduction in postoperative pain and shorter length of hospital stay. [1,2] However, some patients still complain of moderate to severe pain after VATS and postoperative pain control remains challenging [3,4] Although thoracic epidural analgesia (TEA) have been regarded as the gold standard for postoperative pain management in thoracic surgery [5][6][7][8], its complications of epidural hemorrhage, hypotension, and postoperative urinary retention can be fatal to high risk patients. [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Park

et al. 2022

Korean J Anesthesiol

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Postoperative analgesia after minimally invasive thoracoscopy: What should we do?

Cited by 17 publications

References 16 publications

<p>Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial</p>

<p>Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial</p>

Is Intravenous Morphine Alone Effective for Postoperative Analgesia in Bilateral, Single-port Video-Assisted Thoracoscopic Sympathectomy Performed in the Supine Position?

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

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