scholarly journals The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

2021 ◽  
Vol Volume 14 ◽  
pp. 815-825
Author(s):  
Xiao-Long Liang ◽  
Ran An ◽  
Qi Chen ◽  
Hong-Liang Liu
Keyword(s):  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Meta Analysis ◽  
Paravertebral Block ◽  
Thoracic Epidural Anesthesia ◽  
Thoracic Paravertebral Block ◽  
Thoracic Epidural ◽  
Analgesic Effects

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

scholarly journals Meta-analysis of Thoracic Epidural Anesthesia versus  General Anesthesia for Cardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 271-282 ◽  
Author(s):  
Vesna Svircevic ◽  
Diederik van Dijk ◽  
Arno P. Nierich ◽  
Martijn P. Passier ◽  
Cor J. Kalkman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Thoracic Epidural Anesthesia ◽  
Supraventricular Arrhythmias ◽  
Respiratory Complications ◽  
Thoracic Epidural

Background A combination of general anesthesia (GA) with thoracic epidural anesthesia (TEA) may have a beneficial effect on clinical outcomes after cardiac surgery. We have performed a meta-analysis to compare mortality and cardiac, respiratory, and neurologic complications in patients undergoing cardiac surgery with GA alone or a combination of GA with TEA. Methods Randomized studies comparing outcomes in patients undergoing cardiac surgery with either GA alone or GA in combination with TEA were retrieved from PubMed, Science Citation index, EMBASE, CINHAL, and Central Cochrane Controlled Trial Register databases. Results The search strategy yielded 1,390 studies; 28 studies that included 2,731 patients met the selection criteria. Compared with GA alone, the combined risk ratio for patients receiving GA with TEA was 0.81 (95% CI: 0.40-1.64) for mortality, 0.80 (95% CI: 0.52-1.24) for myocardial infarction, and 0.59 (95% CI: 0.24-1.46) for stroke. The risk ratios for the respiratory complications and supraventricular arrhythmias were 0.53 (95% CI: 0.40-0.69) and 0.68 (95% CI: 0.50-0.93), respectively. Conclusions This meta-analysis showed that the use of TEA in patients undergoing cardiac surgery reduces the risk of postoperative supraventricular arrhythmias and respiratory complications. The sparsity of events precludes conclusions about mortality, myocardial infarction, and stroke, but the estimates suggest a reduced risk after TEA. The risk of side effects of TEA, including epidural hematoma, could not be assessed with the current dataset, and therefore TEA should be used with caution until its benefit-harm profile is further elucidated.

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