The role of the perispinal route for postsurgical pain relief

Vercauteren, M.

doi:10.1016/s0950-3501(05)80281-8

Cited by 5 publications

(1 citation statement)

References 98 publications

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“…There are a large number of studies relating to epidural analgesia, particularly with opioids, for thoracotomy and other surgical conditions. Some support the use of various opioids 6 and combinations of opioids with local anaesthetics 6,7 . Others support the use of epidural infusions 8 and the safety of this technique on general wards when supervised appropriately 9 .…”

Section: Discussionmentioning

confidence: 99%

Analgesia following Thoracotomy: A Survey of Australian Practice

Cook

Riley

1996

Anaesth Intensive Care

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This survey examines pain management after thoracotomy in Australian hospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in the analyses. Seventy-two percent of respondents were from hospitals with acute pain services (APS), and in 94% of these hospitals patients are reportedly visited by the APS. The most frequently used analgesic modalities are epidural analgesia, intravenous patient-controlled analgesia (IVPCA), and nurse-controlled intravenous opioid infusions. Over half of the anaesthetists reported using local anaesthetic intercostal nerve block, non-steroidal anti-inflammatory drugs (NSAIDs), or paracetamol. Combinations of analgesic techniques were cited frequently. Respondents reported that cryoanalgesia, interpleural blockade, paravertebral blockade, subarachnoid infusions, ketamine, and transcutaneous electrical nerve stimulation are used infrequently. Anaesthetists from public hospitals reported using epidural analgesia, IVPCA and NSAIDs more frequently than those from private hospitals. When epidural analgesia is used, most respondents place the catheter in the mid-thoracic region (91%), use a regimen of opioids plus local anaesthetic (96%), use a constant infusion technique (100%), and continue analgesia for up to three days (83%). Over half of the respondents reported that post-thoracotomy patients are nursed in a highdependency area. Seventy-nine percent of respondents selected epidural analgesia as the best available analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently ‡ .

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Section: Discussionmentioning

confidence: 99%

Analgesia following Thoracotomy: A Survey of Australian Practice

Cook

Riley

1996

Anaesth Intensive Care

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Regional Anesthesia Complications Related to Acute Pain Management

Rawal¹

2007

Complications of Regional Anesthesia

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Klinischer Einsatz der rückenmarknahen Opioidanalgesie, Teil 1

Rawal

1996

Schmerz

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Spinal opioids are effective analgesics for surgical and non-surgical pain. Central and systemic side effects are less frequent than with epidural local anaesthetics or parenteral opioids. This review focuses on the analgesic efficacy of spinal opioids and their combination with local anaesthetics for postoperative analgesia, including patient-controlled epidural analgesia. Intrathecal administration of opioids has some advantages over their administration by the epidural route. Several factors may influence selection of the opioid; however, in most situations morphine is the drug of choice. Thoracic epidural administration of opioids seems to have no clinically important advantages over the lumbar route in terms of quality of analgesia, adverse effects, doses required or pulmonary function. However, evidence suggesting that effective postoperative analgesia can significantly improve postoperative morbidity in patients at risk is accumulating. In such patients, combined use of epidural local anaesthetics and opioids may become the technique of choice for postoperative analgesia. However, there is no evidence that this would have any clinically relevant benefit in low-risk patients.

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The role of the perispinal route for postsurgical pain relief

Cited by 5 publications

References 98 publications

Analgesia following Thoracotomy: A Survey of Australian Practice

Analgesia following Thoracotomy: A Survey of Australian Practice

Regional Anesthesia Complications Related to Acute Pain Management

Klinischer Einsatz der rückenmarknahen Opioidanalgesie, Teil 1

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