An audit of pain control pathways following video-assisted thoracoscopic surgery (original) (raw)
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PLOS ONE, 2022
Background Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure, but patients may still experience intense pain, especially during the early postoperative period. Intrathecal morphine (ITM) is an effective pain control method that involves a simple maneuver and has a low risk of complications. This study aimed to study the effectiveness of ITM for pain control in patients who undergo VATS. Materials and methods A randomized controlled study was conducted who were in ASA classes 1-3, aged over 18 years, and scheduled for elective VATS. Patients were randomized into two groups: the ITM group (n = 19) received a single shot of 0.2 mg ITM before general anesthesia; and the control group (n = 19) received general anesthesia only. For 48 hours after surgery, other than intravenous patient-controlled analgesia (IVPCA) morphine, patients received no sedatives or opioid medications except for 500 mg acetaminophen four times daily orally. Postoperative pain scores and IVPCA morphine used, side effects, sedation at specific time-points, i.e., 1, 6, 12, 24, and 48-hours and overall treatment satisfaction scores were assessed. Results Postoperative pain scores (median [IQR]) in ITM group were significantly lower than control group (repeated-measure ANOVA, p = 0.006) and differed at the first (7 [2, 7] vs 8 [6, 9], p = 0.007) and sixth hours (3 [2, 5] vs 5 [5, 7], p = 0.002). The cumulative dose of post-operative morphine (median [IQR]) in ITM group was also lower (6 [3, 20] vs 19 [14, 28], p = 0.006). The incidence of pruritus was significantly higher in ITM group (68.42% vs. 26.32%, p = 0.009). No significant differences in nausea and vomiting, sedation scores, and satisfaction scores were observed between the two groups.
Intrapleural Analgesis for Post Thoractomy Pain Management
Introduction: Intrapleural administration of local anesthetic is known to be an excellent method of pain relief after surgery in the upper abdomen and thorax. Intrapleural analgesia consists of the injection of a local anesthetic into the pleural space and is used for postoperative analgesia. The aim of the study was to see the effect of intrapleural analgesia with intermittent injection (0.25 – 0.5%) bupivacaine at 1mg/kg body weight. Material and Methods: The present study was conducted in the department of Cardiothoracic Surgery. All the patients underwent thoracotomy and were randomly distributed into two groups. Group I had 25 patients who received post-operative analgesia in the form of Parenteral Tramadol HCl + Diclofenac Sodium 1mg/ kg 8 th hourly. Group II had 25 received Intrapleural (0.25 to 0.5%) Bupivacaine HCl 1mg/kg 8 th hourly. The pain assessment was done by visual analogue score and visual rating score of Prince Henry. Results: There were 10 male and 15 female patients in group I (mean age: 17.64 years) and 11 male and 14 female patients in group II (mean age: 17.16 years). The mean weight of group I was 28.88 Kg and that of group II was 26.8 Kg. Group I had 15 cases of mitral stenosis and 10 cases of PDA while group II had 14 cases of mitral stenosis and 11 cases of PDA. There was no significant difference in the demographic characteristics between the two groups. At 2 nd post-operative hour, in Group-I most of patients (15/25) were at VAS – 4 where as in Group-II (14/25) were at VAS-2. All were treated with chest physiotherapy and appropriate antibiotics. Conclusions: Intra pleural analgesia, is simple, safe and effective method for post-operative analgesia following thoracotomy procedures. The requirement of opioids and NSAIDS is drastically reduced during post-operative period with minimal adverse effects noted related to intrapleural analgesia. It can be used as safe alternative for post thoracotomy pain management like thoracic epidural analgesia.
Background Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost effectiveness in preventing chronic post-thoracotomy pain. Methods TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomized controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomized in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qua...
European Journal of Cardio-Thoracic Surgery, 2011
The analgesic scheme combining paravertebral block (PVB) and intravenous non-steroidal anti-inflammatory drug (NSAID) has proven to be effective for postoperative pain control after thoracotomy. The hypothesis tested in this study was that this policy was also suitable to improve pain control after video-assisted thoracic surgery (VATS). Methods: This was a prospective randomized study on 40 patients submitted to three-ports' VATS for pneumothorax or solitary pulmonary nodule. The sample size was calculated to detect one point of minimum pain score difference with 80% statistical power. Patients were randomly assigned to two groups: (1) paravertebral block group (PVB) (n = 20)-At the end of surgery, a catheter was placed in patients in the thoracic paravertebral space under camera control; they received a bolus of 15 ml of local anesthetic (ropivacaine 0.2%) every 6 h, combined with endovenous metamizol (1 g); and (2) alternate NSAIDs group (AN) (n = 20)-They were treated with paracetamol (1 g) combined with metamizol (1 g) every 6 h. Subcutaneous meperidine (synthetic opioid) was employed as rescue drug. Both groups were comparable in terms of age, sex, pathology, and co-morbidity. Pain level was measured with the visual analog scale (VAS) at 1, 6, 24, and 48 h. Results: No side effects related to any of the two analgesic techniques were noted. Two patients needed rescue meperidine in the AN group, and none in the PVB group. VAS scores were the following:
Postoperative pain control: videothoracoscopic versus conservative mini-thoracotomic approach
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2014
The management of postoperative pain in thoracic surgery is an open issue. The aim of this study was to compare postoperative pain after a videothoracoscopic lobectomy versus a mini-thoracotomy approach. Between April 2011 and January 2013 we enrolled in a prospective, non-randomized study 145 patients undergoing pulmonary lobectomy with lymphadenectomy for Stage I lung cancer. In 75 cases (Group A), surgery was performed through a videothoracoscopic approach. In 70 cases (Group B), surgery was undertaken through a conservative mini-thoracotomy. Pain was assessed by visual analogue scale and lung function by spirometry and six-minute walking test (6MWT) before surgery, at 48 h and 1 month after surgery. Patients were stratified by age, sex, lung function, type and duration of surgery. Length of hospital stay (median, days) was 4 for Group A and 6 for Group B (P = 0.088). The differences between mean postoperative pain values were significant at 1, 12, 24 and 48 h (6.24 vs 8.74, 5.16...
Journal of Health Sciences and Medicine
Aim: The aim of the study was to compare the effects of ultrasound (US)-guided Erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) on postoperative acute and chronic pain. Material and Method: Patients aged range of 18 to 80 years and underwent video-assisted thoracoscopic surgery (VATS) were included in a single-blinded randomized trial. All patients were informed about the study and their written consent was obtained. The primary outcome was determined as acute postoperative visual analog scale (VAS) scores, and secondary outcomes were postoperative morphine consumption and the incidence of chronic pain. US-guided ESPB and TPVB were performed to all patients and they were assigned randomly to ESPB (Group 1) and TPVB (Group 2) groups according to the analgesia protocol. Results: Visual analog scale (VAS) resting and VAS cough scores at the 1st, 2nd, 4th, 8th, and 16th hours were found to be statistically significantly higher in the TPVB group than in the ESPB ...
British Journal of Anaesthesia, 2012
† This study compared thoracic epidural analgesia (TEA) and a combined thoracic paravertebral block (PVB) and intrathecal opioid (ITO) administration for post-thoracotomy pain relief. † Only small difference in the quality of pain relief was found between both therapies. † Combined PVB and ITO might be an accurate alternative to TEA. Background. Although thoracic epidural analgesia (TEA) is considered the gold standard for post-thoracotomy pain relief, thoracic paravertebral block (PVB) and intrathecal opioid (ITO) administration have also been shown to be efficacious. We hypothesized that the combination of PVB and ITO provides analgesia comparable with that of TEA. Methods. After local ethics committee approval, 84 consecutive patients undergoing open thoracic procedures were randomized to the TEA (ropivacaine 0.2%+sufentanil) or the PVB (ropivacaine 0.5%)+ITO (sufentanil+morphine) group. The primary endpoints were pain intensities at rest and during coughing/movement at 1, 2, 4, 8, 12, 24, 48, and 72 h after operation assessed by visual analogue scale (VAS) score. Data were analysed by multivariate analysis (ANOVA; P,0.05). Results. Patient and surgical characteristics were comparable between the groups. The mean and maximal VAS scores were lower in the TEA (n¼43) than in the PVB+ITO group (n¼37) at several time points at rest (P,0.026) and during coughing/movement (P,0.021). However, in the PVB+ITO group, the mean VAS scores never exceeded 1.9 and 3.5 at rest and during coughing/movement, respectively; and the maximal differences between the groups (TEA vs PVB+ITO) in the maximal VAS scores were only 1.2 (3.4 vs 4.6) at rest, and 1.3 (4.4 vs 5.7) during coughing/movement. Conclusions. Although VAS scores were statistically lower in the TEA compared with the PVB+ITO group at some observation points, the differences were small and of questionable clinical relevance. Thus, combined PVB and ITO can be considered a satisfactory alternative to TEA for post-thoracotomy pain relief. ClinicalTrials.gov number. NCT00493909.
Journal of Clinical Anesthesia, 2017
To evaluate the quality of postoperative pain relief during the first 3 days after surgery and to evaluate with the incidence of persistent pain at 6 months after surgery. Design: Retrospective single-center audit. Setting: University hospital. Patients: Five hundred four patients who underwent thoracotomy. Interventions: Review of patient records, questionnaire, and telephone review. Results: Of the 364 survivors, 306 were contacted. Five or more episodes of severe pain (numerical rating scale N6/ 10 at rest or movement) during the first 72 hours after surgery occurred in 133 patients. Persistent postsurgical pain at 6 months was present in 82% (109/133) of these patients. Patient satisfaction with acute postoperative pain management was excellent (36%), good (43%), and fair or poor (21%).The incidence of postthoracotomy pain was 56% (mild 32%, moderate 18%, and severe 6%). Conclusions: Poorly controlled acute postoperative pain correlated with persistent postsurgical pain at 6 months. In view of such a high incidence in thoracotomy patients, preventative strategies assume great significance.