456 PARAVERTEBRAL AND RECTUS SHEATH CATHETERS AS AN ALTERNATIVE TO THORACIC EPIDURAL FOR ANALGESIA POST-ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
J Ng Cheong Chung ◽  
A Mohammed ◽  
M Navidi ◽  
S Wahed ◽  
A Immanuel ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Rectus Sheath ◽  
High Volume ◽  
Multimodal Analgesia ◽  
Team Members ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Volume Unit ◽  
Vasopressor Use

Abstract   Thoracic epidural (TE) analgesia has been the gold standard for pain management post-esophagectomy and is still being widely used. While it offers excellent analgesia, it can negatively impact on recovery due to hypotension. An alternative is multimodal analgesia using intrathecal-diamorphine, paravertebral and rectus sheaths local anaesthetic infusion-catheters (LAC) and intravenous opioids (PCA). The aim of this study was to compare the effectiveness of TE analgesia and multimodal LAC analgesia and the associated incidence of hypotension. Methods Data were collected over a three-year period for patients who underwent trans-thoracic (Ivor Lewis) esophagectomy from a single high volume unit. Multimodal analgesia was integrated into the patient pathway in early 2016 and adopted by all team members. All patients were treated post operatively with a standardised enhanced recovery pathway. Pain scores using a visual analogue scale (VAS) at rest and movement, episodes of hypotension (systolic BP < 90 mmHg) and vasopressor requirements for post-operative days 0 to 4 (POD 0–4) were recorded for both groups. Results Overall 239 patients were included in this study, 104 patients received TE analgesia and 135 patients received multimodal analgesia. There was no statistically significant difference in the mean VAS pain scores between both cohorts on all post-operative days. (p = 0.06–0.89). In comparison to TE analgesia, the multimodal patient group had significantly fewer episodes of hypotension (multimodal: 21% vs TE: 38%, p = 0.01) and significantly less vasopressor infusion requirements to maintain their blood pressure (multimodal: 30% vs TE: 55%, p = 0.01). Conclusion Multimodal analgesia using intrathecal diamorphine with combined paravertebral and rectus sheath catheters is not inferior to TE in providing pain control post esophagectomy. In addition there are significantly fewer episodes of hypotension and significantly less need for vasopressor use. This may confer a postoperative advantage permitting better patient mobilisation and recovery in the immediate post operative period.

scholarly journals A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery (the LapCoGesic study)

2020 ◽  
Vol 102 (1) ◽  
pp. 28-35
Author(s):  
L Brown ◽  
M Gray ◽  
B Griffiths ◽  
M Jones ◽  
A Madhavan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Outcome Measure ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Patient Controlled Analgesia ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Patient Reported ◽  
Observational Cohort

Introduction Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. Materials and methods A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. Results A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. Discussion Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.

scholarly journals Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

2020 ◽  
Vol 45 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Laura Beard ◽  
Carl Hillermann ◽  
Emma Beard ◽  
Sue Millerchip ◽  
Rajneesh Sachdeva ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Negative Binomial ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Regional Analgesia ◽  
Cross Sectional ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Anterior Plane

BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

The effect of PECS-1 block on postoperative pain in total implantable venous access port catheter (TIVAP) insertion

2021 ◽  
pp. 112972982110346
Author(s):  
Özcan Pişkin ◽  
Bülent Altınsoy ◽  
Çağdaş Baytar ◽  
Bengü Gülhan Aydın ◽  
Dilek Okyay ◽  
...  
Keyword(s):  
Venous Access ◽  
Multimodal Analgesia ◽  
Anterior Chest Wall ◽  
Controlled Study ◽  
Rescue Analgesia ◽  
Access Port ◽  
Pain Scores ◽  
Significant Difference ◽  
Vas Scores ◽  
Infiltration Anesthesia

Background: The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of US-guided Pectoral (PECS) I blocks on postoperative analgesia after TIVAP insertion. Methods: A hundred-twenty patients were included in this study. The patients were divided into two groups: Group PECS and Group INF (infiltration). A total 0.4 mL kg−1 0.25% bupivacaine was injected to below the middle of the clavicle in the interfascial space between the pectoralis major and minor muscles for PECS-1. The skin and deep tissue infiltration of the anterior chest wall was performed with 0.4 mL kg−1 0.25% bupivacaine for INF group. Tramadol and paracetamol consumption, visual analog scale pain scores were recorded at 0, 1, 4, 12, and 24 h postoperatively. Results: The use of the PECS in TIVAP significantly decreased the amount of paracetamol used in the first 24 h postoperatively ( p < 0.001). There was a statistically significant difference in the number of tramadol rescue analgesia administered between the groups ( p < 0.001) There was no significant difference between the groups in terms of the VAS scores at 0 and 24 h. However, VAS scores at 1, 4, and 12 h were found to be significantly lower in patients who underwent PECS than in those who received infiltration anesthesia ( p < 0.001). Conclusions: This study shows that US-guided PECS-1 provides adequate analgesia following TIVAP insertion as part of multimodal analgesia. The PECS-1 significantly reduced opioid consumption.

scholarly journals Analgesic effect of combined transversus abdominis plane block and rectus sheath block in laparoscopic cholecystectomy: prospective randomized study

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Ibrahim Hakki Tor ◽  
Erkan Cem Çelik ◽  
Muhammed Enes Aydın
Keyword(s):  
Rectus Sheath ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Time Intervals ◽  
Wound Infiltration ◽  
Pain Scores ◽  
Group I ◽  
Rectus Sheath Block ◽  
Significant Difference ◽  
Vas Scores

Abstract Background We aimed to investigate the combination of the subcostal transversus abdominis plane block and rectus sheath block (ScTAP-RS) versus wound infiltration on opioid consumption and assess effects on pain scores in laparoscopic cholecystectomy (LC). One hundred patients scheduled for LC were included in this study following the local ethics committee approval. Patients were randomized and divided into two groups as group ScTAP-RS and wound infiltration group (group I). After the surgical intervention, in group ScTAP-RS, ScTAP-RS block with 30 ml 0.25% bupivacaine solution was administered by ultrasound, and in group I, 20 ml 0.25% bupivacaine solution was injected in three port incision sites. Patient-controlled analgesia with tramadol was programmed for 24 h postoperatively. Tramadol consumptions and visual analog scale (VAS) scores were evaluated. Results Compared to the infiltration group, total tramadol consumption was significantly lower in the ScTAP-RS group between 4 and 12 h. There was no statistically significant difference between the groups in other time intervals. VAS scores were significantly lower in the ScTAP-RS group in the 4th and 8th hours at rest and ambulation. There was no statistically significant difference between the groups for VAS scores at other time intervals. Conclusion ScTAP-RS blocks decrease the opioid consumption and pain scores compared to the local infiltration after LC.

scholarly journals Single-port VATS combined with non-indwelling drain in ERAS: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiantian Yang ◽  
Wencong Huang ◽  
Peijian Li ◽  
Huizhen Hu ◽  
Yongsheng Li ◽  
...  
Keyword(s):  
Single Port ◽  
Enhanced Recovery ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Pain Scores ◽  
Significant Difference ◽  
Lower Pain ◽  
Drain Group ◽  
Hospital Stays ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background We investigated single-port video-assisted thoracoscopic surgery (VATS) combined with a postoperative non-indwelling drain in enhanced recovery after surgery (ERAS). Methods The clinical data of 127 patients who underwent double- and single-port VATS from January 2018 to December 2019 were analyzed retrospectively. The groups constituted 71 cases undergoing double-port and 56 cases undergoing single-port VATS (30 cases in the indwelling drain group and 26 cases in the non-indwelling drain group). The incidence of postoperative complications, pain scores, and postoperative hospital stay were compared between the two groups. Results Compared with the double-port group, the single-port group had shorter postoperative hospital stays and lower pain scores on the first and third postoperative days (P < 0.05). Pain scores on the first and third days were lower in the single-port non-indwelling drain group than in the single-port indwelling drain group (P < 0.05), and the postoperative hospitalization time was significantly shorter in the single-port group (P < 0.05). However, there was no significant difference between the two groups for operation time, incidence of complications, and pain scores 1 month after operation (P > 0.05). Conclusions The combination of single-port VATS with a non-indwelling drain can relieve postoperative pain, help patients recover quickly, and is in accordance with ERAS.

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

2019 ◽  
Vol 29 (5) ◽  
pp. 935-943 ◽  
Author(s):  
Amanda Rae Schwartz ◽  
Stephanie Lim ◽  
Gloria Broadwater ◽  
Lauren Cobb ◽  
Fidel Valea ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Oral Morphine ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Opioid Use ◽  
Pain Scores ◽  
Significant Difference ◽  
Eras Protocol

ObjectiveEnhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol.MethodsA retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014–7/27/2016) with comparison to a historical cohort (6/23/2013–9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher’s exact, and chi squared tests.ResultsOne hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates.ConclusionsERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.

scholarly journals Evolution of Esophagectomy for Cancer Over 30 Years: Changes in Presentation, Management and Outcomes

2020 ◽  
Author(s):  
S. Michael Griffin ◽  
Rhys Jones ◽  
Sivesh Kathir Kamarajah ◽  
Maziar Navidi ◽  
Shajahan Wahed ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Enhanced Recovery ◽  
High Volume ◽  
Single Center ◽  
Long Term Outcomes ◽  
Changing Trends ◽  
Radio Therapy ◽  
Volume Unit ◽  
Esophagectomy For Cancer

Abstract Background Esophageal cancer has seen a considerable change in management and outcomes over the last 30 years. Historically, the overall prognosis has been regarded as poor; however, the use of multimodal treatment and the integration of enhanced recovery pathways have improved short- and long-term outcomes. Objective The aim of this study was to evaluate the changing trends in presentation, management, and outcomes for patients undergoing surgical treatment for esophageal cancer over 30 years from a single-center, high-volume unit in the UK. Patients and Methods Data from consecutive patients undergoing esophagectomy for cancer (adenocarcinoma or squamous cell carcinoma) between 1989 and 2018 from a single-center, high-volume unit were reviewed. Presentation method, management strategies, and outcomes were evaluated. Patients were grouped into successive 5-year cohorts for comparison and evaluation of changing trends. Results Between 1989 and 2018, 1486 patients underwent esophagectomy for cancer. Median age was 65 years (interquartile range [IQR] 59–71) and 1105 (75%) patients were male. Adenocarcinoma constituted 1105 (75%) patients, and overall median survival was 29 months (IQR 15–68). Patient presentation changed, with epigastric discomfort now the most common presentation (70%). An improvement in mortality from 5 to 2% (p < 0.001) was seen over the time period, and overall survival improved from 22 to 56 months (p < 0.001); however, morbidity increased from 54 to 68% (p = 0.004). Conclusions Long-term outcomes have significantly improved over the 30-year study period. In addition, mortality and length of stay have improved despite an increase in complications. The reasons for this are multifactorial and include the use of perioperative chemo(radio)therapy, the introduction of an enhanced recovery pathway, and improved patient selection.

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