Subpleural block is less effective than thoracic epidural analgesia for post-thoracotomy pain

Kanazi, Ghassan E.; Ayoub, Chakib M.; Aouad, Marie T.; Abdallah, Faraj W.; Sfeir, Pierre; Adham, Almoataz-Billah F.; El-Khatib, Mohamad

doi:10.1097/eja.0b013e32834fcef7

Cited by 22 publications

(34 citation statements)

References 20 publications

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“…Previous studies have suggested that local anesthetic doses for TEA should be half those of subpleural analgesia. 4,5 In the current study, the starting bolus doses were given at a ratio of 1:2, but the PCA doses were lower than the doses used in the study by Kanazi et al For supplemental therapy, paracetamol and diclofenac sodium were used in the current study. These bupivacaine doses in the TEA group were sufficient for analgesia, and reduced the rate of complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, Kanazi et al 4 reported that the incidence of hypotension was between the groups during the study period. None of the patients had hypotension or side effects.…”

Section: -13mentioning

confidence: 99%

“…Kanazi et al 4 determined that the pain scores when coughing were higher than at rest in all their patients and at all times, whether using TEA or SPA, and that VAS scores when coughing were always lower in the TEA group than in the SPA group.…”

Section: -13mentioning

confidence: 99%

“…1,2 Various analgesic techniques have been developed to treat postoperative thoracotomy pain. [1][2][3][4][5][6] Thoracic epidural analgesia is the gold standard not only for pain relief after thoracotomy, but also because of its many beneficial effects, such as reduction of intraoperative opioid requirements, improvement of postoperative cardiopulmonary function and suppression of stress response. [1][2][3][4][5][6] Thoracic epidural block is usually performed percutaneously, with considerable failure rates.…”

Section: Introductionmentioning

confidence: 99%

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Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

et al. 2015

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CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patientcontrolled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patientcontrolled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. CONCLUSION: Thoracic epidural analgesia is superior to subpleural analgesia for relieving postthoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.RESUMO CONTEXTO E OBJETIVO: Dor pós-toracotomia é severa e intensa, causada por trauma de nervos periféricos, músculos e costelas. O objetivo foi comparar analgesia subpleural (SPA) com analgesia epidural torácica (TEA) em pacientes submetidos à toracotomia. TIPO DE ESTUDO E LOCAL: Estudo randomizado no Hospital Educação e Pesquisa de Numune, em Ancara, Turquia. MÉTODOS: Trinta pacientes com o estado físico I-III da Sociedade Americana de Anestesiologistas foram agendados para toracotomia diagnóstica eletiva e escolhidos aleatoriamente para receber, num período de 24 horas, SPA ou TEA, ambas controladas pelo próprio paciente, para controle da dor pós-toracotomia. Os dois grupos receberam mistura de 3 ug/ml de fentanil com solução de 0,05% de bupivacaína por meio de bomba de analgesia controlada pelo paciente. Foi administrada analgesia de resgate por via intravenosa, com 100 mg de tramadol, nos dois grupos. No pós-operatório, a escala visual analógica foi utilizada para medir presença de dor durante a tosse ou em repouso, ao longo de 24 horas. RESULTADOS: No grupo SPA, todos os pacientes necessitaram de analgesia de resgate. Cinco pacientes (33%) necessitaram de analgesia de resgate no grupo TEA (P < 0,05). Os pacientes com SPA exibiram pontuações superiores na escala visual analógica, em repouso e ao tossir, em comparação aos que receberam TEA. Nenhum dos pacientes teve quaisquer efeitos...

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Section: Discussionmentioning

confidence: 99%

“…However, Kanazi et al 4 reported that the incidence of hypotension was between the groups during the study period. None of the patients had hypotension or side effects.…”

Section: -13mentioning

confidence: 99%

Section: -13mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

et al. 2015

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“…There are several options for analgesia after thoracic surgery, including thoracic epidural anesthesia, thoracic paravertebral blockade, IV-PCA, local anesthetic infusion in the wound or extrapleural space, and combinations of these methods (6,10). Epidural PCA has proven to be effective for pain control (6,11,12), but thoracic epidural catheterization has risks of dural puncture, epidural hematoma formation, nerve damage, hypotension, and unsuccessful catheter placement (7). The catheterization also takes time and the success rate usually depends on operator experience.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of subpleural continuous infusion of local anesthetics after thoracoscopic pulmonary resection for primary lung cancer compared to intravenous patient-controlled analgesia

Jung¹,

Park²,

Haam³

2016

J. Thorac. Dis.

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Paravertebral block versus thoracic epidural for patients undergoing thoracotomy

Yeung

Gates

Naidu

et al. 2016

Cochrane Database of Systematic Reviews

316

251

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Subpleural block is less effective than thoracic epidural analgesia for post-thoracotomy pain

Abstract: Thoracic epidural analgesia is superior to subpleural analgesia in relieving post-thoracotomy pain.

Cited by 22 publications

References 20 publications

Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

Efficacy of subpleural continuous infusion of local anesthetics after thoracoscopic pulmonary resection for primary lung cancer compared to intravenous patient-controlled analgesia

Paravertebral block versus thoracic epidural for patients undergoing thoracotomy

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