Comparative Effects of Thoracic Epidural Analgesia and Intrathecal Analgesia on Pain Relief and Respiratory Function after Thoracic Surgery

2002 ◽  
Vol 96 (Sup 2) ◽  
pp. A914
Author(s):  
Celine M. Adaimi ◽  
Samia N. Madi-Jebara ◽  
Alexandre G. Yazigi ◽  
Fadia A. Haddad ◽  
Gemma N. Hayek
Keyword(s):  
Pain Relief ◽  
Epidural Analgesia ◽  
Thoracic Surgery ◽  
Respiratory Function ◽  
Thoracic Epidural Analgesia ◽  
Thoracic Epidural ◽  
Intrathecal Analgesia

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Mu Xu ◽  
Jiajia Hu ◽  
Jianqin Yan ◽  
Hong Yan ◽  
Chengliang Zhang
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Cochrane Library ◽  
Thoracic Epidural ◽  
Analgesic Consumption ◽  
Postthoracotomy Pain

Abstract Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

Postoperative Analgesia after Radical Retropubic Prostatectomy

2006 ◽  
Vol 105 (4) ◽  
pp. 784-793 ◽  
Author(s):  
Anil Gupta ◽  
Federica Fant ◽  
Kjell Axelsson ◽  
Dag Sandblom ◽  
Jan Rykowski ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Short Form ◽  
Radical Retropubic Prostatectomy ◽  
Thoracic Epidural Analgesia ◽  
Short Form 36 ◽  
Thoracic Epidural ◽  
Retropubic Prostatectomy ◽  
Intravenous Analgesia

Background Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated. Low thoracic epidural analgesia and patient-controlled intravenous analgesia were compared in this double-blind, randomized study. Methods Sixty patients were randomly assigned to receive either low thoracic epidural analgesia (group E) or patient-controlled intravenous analgesia (group P) for postoperative pain relief. All patients had general anesthesia combined with thoracic epidural analgesia during the operation. Postoperatively, patients in group E received an infusion of 1 mg/ml ropivacaine, 2 microg/ml fentanyl, and 2 microg/ml adrenaline, 10 ml/h during 48 h epidurally, and a placebo patient-controlled intravenous analgesia pump intravenously. Patients in group P received a patient-controlled intravenous analgesia pump with morphine intravenously and 10 ml/h placebo epidurally. Pain, the primary outcome variable, was measured using the numeric rating scale at rest (incision pain and "deep" visceral pain) and on coughing. Secondary outcome variables included gastrointestinal function, respiratory function, mobilization, and full recovery. Health-related quality of life was measured using the Short Form-36 questionnaire, and plasma concentration of fentanyl was measured in five patients to exclude a systemic effect of fentanyl. Results Incisional pain and pain on coughing were lower in group E compared with group P at 2-24 h, as was deep pain between 3 and 24 h postoperatively (P &lt; 0.05). Maximum expiratory pressure was greater in group E at 4 and 24 h (P &lt; 0.05) compared with group P. No difference in time to home discharge was found between the groups. The mean plasma fentanyl concentration varied from 0.2 to 0.3 ng/ml during 0-48 h postoperatively. At 1 month, the scores on emotional role, physical functioning, and general health of the Short Form-36 were higher in group E compared with group P. However, no group x time interaction was found in the Short Form-36. Conclusions The authors found evidence for better pain relief and improved expiratory muscle function in patients receiving low thoracic epidural analgesia compared with patient-controlled analgesia for radical retropubic prostatectomy. Low thoracic epidural analgesia can be recommended as a good method for postoperative analgesia after abdominal surgery.

Thoracic Epidural Analgesia With Levobupivacaine for 6 Postoperative Days Attenuates Sympathetic Activation After Thoracic Surgery

2011 ◽  
Vol 25 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Marina Simeoforidou ◽  
George Vretzakis ◽  
Metaxia Bareka ◽  
Eleni Chantzi ◽  
Andreas Flossos ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Thoracic Surgery ◽  
Thoracic Epidural Analgesia ◽  
Sympathetic Activation ◽  
Thoracic Epidural

Continuous Thoracic Epidural Analgesia for Postoperative Pain Relief Following Thoracotomy

1987 ◽  
Vol 67 (5) ◽  
pp. 787-791 ◽  
Author(s):  
WILLIAM G. LOGAS ◽  
NABIL EL-BAZ ◽  
ABDEL EL-GANZOURI ◽  
MARC CULLEN ◽  
EDGAR STAREN ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Postoperative Pain Relief ◽  
Thoracic Epidural

Pain Management Strategies for Thoracic Surgery

2019 ◽  
Author(s):  
Brett Weiner ◽  
Harman Boparai ◽  
Grant H. Chen
Keyword(s):  
Pain Management ◽  
Epidural Analgesia ◽  
Thoracic Surgery ◽  
Enhanced Recovery ◽  
Opioid Analgesic ◽  
Thoracic Epidural Analgesia ◽  
Anesthetic Techniques ◽  
Perioperative Morbidity ◽  
Thoracic Epidural ◽  
Regional Anesthetic

Improper management of postoperative pain following thoracic surgery can be quite debilitating and lead to a number of complications due to the multitude of comorbid conditions manifested by the population of patients undergoing these types of procedures. These can include advanced lung disease, advanced age, heart disease, renal insufficiency and obesity.¹ The source of this acute postsurgical pain is multifactorial and can include skin incisions, deep tissue injuries, thoracostomy tubes, costovertebral joint separation and rib or sternal fractures.² Benefits of effective analgesia include decreased risk of perioperative morbidity, decreased hospital stay, decreased cost and increased patient satisfaction.³ There have been numerous studies conducted to determine the best pain management regimen for control of postthoracotomy pain, however, no single technique has thus far proven to be superior. Instead, most clinicians would advocate for a multimodal approach combining regional techniques, such as thoracic epidural analgesia or paravertebral blocks, with systemic analgesic medications including a combination of cyclooxygenase (COX)-2 inhibitors, nonsteroidal anti-inflammatory drugs, opioids and other analgesic adjuncts. This chapter will examine the different analgesic options currently available and being utilized for various types of thoracic surgical procedures. This will include a review of the systemic analgesic and non-analgesic optiondis as well as regional anesthetic techniques. The chapter will conclude with a discussion of chronic post-thoracotomy pain syndrome and currently available treatments. This review contains 4 tables, and 87 references. Keywords: systemic analgesic therapy, opioid analgesic medications, regional anesthetic techniques, thoracic epidural analgesia, paravertebral analgesia, chronic post-thoracotomy pain management, Enhanced Recovery After Surgery (ERAS), intrathecal opioid analgesia, intercostal analgesia, intrapleural analgesia

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