Abstract
References
- Tamura T, Mori S, Mori A, et al. A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief. J Anesth 2017; 31: 263-70.
- Sentürk M, Ozcan PE, Talu GK, et al. The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 2002; 94: 11-5.
- Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth 2017; 31: 152-8.
- Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin 2005; 15: 105-21.
- Rogers ML, Henderson L, Mahajan RP, Duffy JP. Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy. Eur J Cardiothorac Surg 2002; 21: 298-301.
- Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth 2006; 96: 418-26.
- Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107: 1026-40.
- Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 2010; 105: 842-52.
- Madabushi R, Tewari S, Gautam SK, Agarwal A, Agarwal A. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician 2015; 18: E421-4.
- Barbera C, Milito P, Punturieri M, Asti E, Bonavina L. Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study. J Pain Res 2017; 4: 73-7.
- Özden Omaygenç D, Çıtak N, İşgörücü Ö, et al. Comparison of thoracic epidural and intravenous analgesia from the perspective of recovery of respiratory function in the early post-thoracotomy period in lung cancer surgery. Turk Thorac J 2021; 22: 31-6.
- Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95: 771-80.
- D’Ercole F, Arora H, Kumar PA. Paravertebral block for thoracic surgery. J Cardiothorac Vasc Anesth 2018; 32: 915-27.
- Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med 2019; 7: 174.
- Wojtyś ME, Wąsikowski J, Wójcik N, et al. Assessment of postoperative pain management and comparison of effectiveness of pain relief treatment involving paravertebral block and thoracic epidural analgesia in patients undergoing posterolateral thoracotomy. J Cardiothorac Surg 2019; 14: 78.
- Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016; 2: CD009121.
- Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg 2005; 80: 1550-9.
- Kotzé A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth 2009; 103: 626-36.
- Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 1999; 83: 387-92.
- Kupersztych-Hagege E, Dubuisson E, Szekely B, et al. Epidural hematoma and abscess related to thoracic epidural analgesia: a single-center study of 2,907 patients who underwent lung surgery. J Cardiothorac Vasc Anesth 2017; 31: 446-52.
- El Shora HA, El Beleehy AA, Abdelwahab AA, et al. Bilateral paravertebral block versus thoracic epidural analgesia for pain control post-cardiac surgery: a randomized controlled trial. Thorac Cardiovasc Surg 2020; 68: 410-6.
- Conlon NP, Shaw AD, Grichnik KP. Postthoracotomy paravertebral analgesia: will it replace epidural analgesia? Anesthesiol Clin 2008; 26: 369-80.
- Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg 2019; 32: 121-8.
- Gupta R, Van de Ven T, Pyati S. Post-thoracotomy pain: current strategies for prevention and treatment. Drugs 2020; 80: 1677-84.
- Batchelor TJP, Ljungqvist O. A surgical perspective of ERAS guidelines in thoracic surgery. Curr Opin Anaesthesiol 2019; 32: 17-22.
- Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014; 101: 172-88.
- Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019; 55: 91-115.
Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy
Abstract
Aim: Thoracotomy is among the most painful surgical incisions and causes severe acute pain in the postoperative period. Many analgesic methods have been suggested for thoracotomy pain treatment. Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are common regional methods for post-thoracotomy pain. In this study, we aimed to compare the efficacy and the side effects of TEA and TPVB methods applied for post-thoracotomy analgesia.
Material and Method: After ethical committee approval, we retrospectively analyzed postoperative analgesia records of patients, who underwent thoracotomy, received TEA or TPVB for postoperative analgesia between 01.01.2019 and 01.01.2021. Visual analog scale (VAS) scores of the patients who received analgesic treatment for 24 hours postoperatively after TEA or TPVB application were evaluated.
Results: Data of 474 patients were found eligible for analysis. Demographic data of patients, VAS scores, patient satisfaction, and additional analgesic requirements were not statistically significant between the groups (p>0.05). Nausea-vomiting, hypotension, headache, itching, and sweating was statistically significantly higher in the TEA group when compared to patients who underwent TPVB (p<0.05).
Conclusion: In the present study, in the early postoperative pain management after thoracotomy; it was observed that preemptive TPVB and postoperative IV patient-controlled analgesia (PCA) and TEA provided similar VAS scores and additional analgesic requirements. On the other hand, postoperative complications were observed less frequently in patients who underwent TPVB with postoperative IV PCA compared to TEA. Therefore, TPVB may be a good alternative to prevent acute pain after thoracotomy.
Keywords
Postoperative acute pain thoracic epidural analgesia thoracic paravertebral block thoracotomy
References
- Tamura T, Mori S, Mori A, et al. A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief. J Anesth 2017; 31: 263-70.
- Sentürk M, Ozcan PE, Talu GK, et al. The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 2002; 94: 11-5.
- Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth 2017; 31: 152-8.
- Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin 2005; 15: 105-21.
- Rogers ML, Henderson L, Mahajan RP, Duffy JP. Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy. Eur J Cardiothorac Surg 2002; 21: 298-301.
- Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth 2006; 96: 418-26.
- Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107: 1026-40.
- Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 2010; 105: 842-52.
- Madabushi R, Tewari S, Gautam SK, Agarwal A, Agarwal A. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician 2015; 18: E421-4.
- Barbera C, Milito P, Punturieri M, Asti E, Bonavina L. Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study. J Pain Res 2017; 4: 73-7.
- Özden Omaygenç D, Çıtak N, İşgörücü Ö, et al. Comparison of thoracic epidural and intravenous analgesia from the perspective of recovery of respiratory function in the early post-thoracotomy period in lung cancer surgery. Turk Thorac J 2021; 22: 31-6.
- Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95: 771-80.
- D’Ercole F, Arora H, Kumar PA. Paravertebral block for thoracic surgery. J Cardiothorac Vasc Anesth 2018; 32: 915-27.
- Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med 2019; 7: 174.
- Wojtyś ME, Wąsikowski J, Wójcik N, et al. Assessment of postoperative pain management and comparison of effectiveness of pain relief treatment involving paravertebral block and thoracic epidural analgesia in patients undergoing posterolateral thoracotomy. J Cardiothorac Surg 2019; 14: 78.
- Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016; 2: CD009121.
- Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg 2005; 80: 1550-9.
- Kotzé A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth 2009; 103: 626-36.
- Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 1999; 83: 387-92.
- Kupersztych-Hagege E, Dubuisson E, Szekely B, et al. Epidural hematoma and abscess related to thoracic epidural analgesia: a single-center study of 2,907 patients who underwent lung surgery. J Cardiothorac Vasc Anesth 2017; 31: 446-52.
- El Shora HA, El Beleehy AA, Abdelwahab AA, et al. Bilateral paravertebral block versus thoracic epidural analgesia for pain control post-cardiac surgery: a randomized controlled trial. Thorac Cardiovasc Surg 2020; 68: 410-6.
- Conlon NP, Shaw AD, Grichnik KP. Postthoracotomy paravertebral analgesia: will it replace epidural analgesia? Anesthesiol Clin 2008; 26: 369-80.
- Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg 2019; 32: 121-8.
- Gupta R, Van de Ven T, Pyati S. Post-thoracotomy pain: current strategies for prevention and treatment. Drugs 2020; 80: 1677-84.
- Batchelor TJP, Ljungqvist O. A surgical perspective of ERAS guidelines in thoracic surgery. Curr Opin Anaesthesiol 2019; 32: 17-22.
- Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014; 101: 172-88.
- Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019; 55: 91-115.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | January 21, 2022 |
| Publication Date | January 24, 2022 |
| Published in Issue | Year 2022 Volume: 4 Issue: 1 |
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