Regional analgesia for lung transplantation

Abstract

Lung transplantation (LTx) is the definitive treatment for end-stage pulmonary disease. About 4500 LTxs are performed annually worldwide.It is considered challenging and complex surgery regarding anaesthesia and pain management. While providing adequate analgesia is crucial for patient comfort, early mobilisation and prevention of postoperative pulmonary complications, standardising an analgesic protocol is challenging due to the diversity of aetiologies, surgical approaches and the potential use of extracorporeal life support (ECLS).Although thoracic epidural analgesia is commonly considered the gold standard, concerns regarding procedural safety and its potential for devastating consequences have led physicians to seek safer analgesic modalities such as thoracic nerve blocks.The advantages of thoracic nerve blocks for general thoracic surgery are well established. However, their utility in LTx remains unclear.Considering paucity of relevant literature, this review aims to raise awareness about the literature gap in the field and highlight the need for further high-quality studies determining the effectiveness of available techniques.

Chronic Postsurgical Pain Following Lung Transplantation: Characteristics, Risk Factors, Treatment, and Prevention: A Narrative Review

“…Local analgesia can be quite effective after general thoracic surgery and regional anesthesia can significantly reduce the incidence of CPSP [ 63 ], but whether the same is true for patients undergoing LTx remains to be seen. Future research should examine this question, especially since a wide range of analgesia methods have been applied successfully to such patients [ 64 ]. One study [ 64 ] summarized the advantages and disadvantages of different regional analgesic modalities for LTx.…”

“…Future research should examine this question, especially since a wide range of analgesia methods have been applied successfully to such patients [ 64 ]. One study [ 64 ] summarized the advantages and disadvantages of different regional analgesic modalities for LTx. Anticoagulation treatment of extracorporeal life support limits the application of thoracic segmental epidural analgesia for LTx procedures.…”

“…Anticoagulation treatment of extracorporeal life support limits the application of thoracic segmental epidural analgesia for LTx procedures. The thoracic paravertebral block, serratus anterior plane block, erector spinae plane block, thoracic nerve block, intercostal nerve block, and cryoablation techniques have also been used for local analgesia during and after LTx [ 64 ], and these new techniques may be promising analgesic approaches for LTx surgery. Recently, research from our medical center has shown that postoperative multimodal analgesia involving the combination of a serratus anterior plane block catheter and systemic analgesia can control post-transplantation pain effectively.…”

“…Indeed, multimodal analgesia can reduce the neuropathic component of postoperative pain after thoracotomy in various clinical contexts, which in turn may decrease the incidence of CPSP [ 67 , 68 ], a possibility that should be explored for lung transplant recipients. In this regard, a multimodal approach combining complementary systemic and local analgesia may be most effective for achieving synergies and minimizing adverse effects [ 64 ]. Overall, studies of local analgesic techniques in LTx are scarce and involve mostly case reports or case series, so the level of evidence is weak.…”