Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients

We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.

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Patient with Postthoracotomy Pain

10.2310/pm.15013 ◽

2017 ◽

Author(s):

Jianguo Cheng ◽

Olivia T Cheng

Keyword(s):

Spinal Cord ◽

Epidural Analgesia ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Intercostal Nerve ◽

Thoracic Epidural Analgesia ◽

Intercostal Nerve Block ◽

Thoracic Epidural ◽

Postthoracotomy Pain ◽

Intravenous Analgesia

Pain due to thoracotomy is among the most severe pain experienced after surgery. It has both neuropathic and myofascial components. About 50% of patients suffer from chronic postthoracotomy pain 1 year after surgery. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapy for thoracotomy analgesia. Preoperatively initiated thoracic epidural analgesia is associated with better pain control and decreased incidence (and intensity) of chronic postthoracotomy pain compared with postoperative (epidural or intravenous) analgesia. Compared with inhalation anesthesia, total intravenous anesthesia significantly reduced the incidence of chronic postthoracotomy pain syndrome, which is notoriously challenging to treat. Gabapentinoids and antidepressants may be beneficial for the neuropathic component of chronic postthoracotomy pain syndrome. A pregabalin and methylcobalamin combination has been shown to be safe and effective in the treatment of chronic postthoracotomy pain, with minimal side effects. Interventional therapies such as intercostal nerve block or ablation, spinal cord stimulation, and targeted subcutaneous neuromodulation may be indicated in more refractory and debilitating cases. This review contains 1 table, and 57 references. Key words: chronic postthoracotomy pain, cryoneurolysis, intercostal nerve block, open thoracotomy surgery, paravertebral block, postthoracotomy pain, postthoracotomy pain syndrome, spinal cord stimulation, thoracic epidural analgesia, thoracotomy, total intravenous analgesia, video-assisted thoracoscopic surgery

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Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy

Clinical & Investigative Medicine ◽

10.25011/cim.v38i6.26197 ◽

2015 ◽

Vol 38 (6) ◽

pp. 351 ◽

Cited By ~ 1

Author(s):

Jinzhuan Chen ◽

Jianqing Lin ◽

Xiaoming Chen ◽

Caizhu Lin

Keyword(s):

Elderly Patients ◽

General Anesthesia ◽

Nerve Block ◽

Distal Gastrectomy ◽

Intercostal Nerve ◽

Intercostal Nerve Block ◽

Arterial Blood ◽

Anesthesia Group ◽

Group A ◽

Group B

Purpose: The purpose of this study was to evaluate the efficacy and safety of administration of an intercostal nerve block (INB) with general anesthesia to elderly patients undergoing a distal gastrectomy. Methods: Elderly patients (>65 years) undergoing selective gastrectomy were randomly assigned to three groups (n = 80): general anesthesia (Group A); general + INB anesthesia (Group B); or, general + epidural anesthesia (Group C). General anesthesia was maintained with propofol, remifentanil and cisatracurium. The mean arterial blood pressure (MAP), heart rate (HR) and C-reactive protein (CRP) levels were determined before anesthesia (T0) and at 5 min after intubation (T1), skin incision (T2), exploration of the peritoneal cavity (T3), gastrointestinal anastomosis (T4), end of operation (T5) and 10 min after extubation (T6). Results: MAP decreased at T1 in all groups (P < 0.05) and at T2, T4 and T5 in Group C (P < 0.05) and was lower in Group C than Group B at T2 and T4 (P < 0.05). There were no differences in MAP between Groups A and B or between Groups B and C. HR increased at T2 - T6 in Group A (P < 0.05) and was higher at T2 - T6 in Group B and Group C (P < 0.05). CRP levels decreased at T2 - T5 in Groups B and C (P < 0.05) and were lower in Groups B and C compared with Group A (P < 0.05). Propofol and remifentanil doses were lower in Groups B and C (P < 0.05 and P < 0.01, respectively) and patients recovered faster than in Group A (P < 0.05). Conclusion: Administration of INB with general anesthesia enhanced analgesia, led to stable hemodynamics, and reduced anaesthetic consumption and postoperative stress response.

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To compare the frequency of postoperative sore throat with I-gel versus laryngeal mask airway in patients

10.53350/pjmhs2115123232 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3232-3235

Author(s):

M. J. Ahmed Kamal ◽

Baber Zaheer ◽

Naveed Ahmed Durrani ◽

Khaleel Ahmad ◽

Sumara Tabassam ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Sore Throat ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Postoperative Sore Throat ◽

Significant Difference ◽

Group A ◽

Group Members ◽

Group B

Background: In case of general anesthesia, airway maintenance along with least complications is the most important goal of team of anesthesiologists. In case of clinical practice, the laryngeal mask airway (LMA) devices have superiority in managing supraglottic airway. Recently i-gel airway has been introduced as supraglottic airway equipment (disposable). Aim: To make comparison between laryngeal mask and I-gel with respect to postoperative complication of sore throat in case of patients who were given general anesthesia. Study design: Randomized trial Setting: Anesthesia Department Study duration: 6 after synopsis approval in total 6months of duration Methods: Candidates were divided randomly divided into two groups. In case of members of group A, patients were given i-gel where as members of group B, disposable LMA was given. General anesthesia was administered according to the standardized protocols. A day after operation, candidates were check post operatively for 24 hours, for sore throat and information was documented on Performa. Results: The candidates mean age was 44.23±15.11years in case of i-gel group members whereas 46.10±15.56 years in case of LMA group. In case of i-gel group, there were about twenty five males members and thirty five were females members . In case of LMA group members, there were about twenty six males and thirty four female members . In present case research, sore throat postoperatively was seen in case of 17(14.2%) cases, i.e. 4 (6.7%) in i-gel group while 13(21.7%) in case of LMA group. The significant difference was witnessed between members of both groups (p<0.05). Conclusion: Thus i-gel is better than LMA for general anesthesia as it has fewer chances of side effects like postoperative sore throat. Keywords: Postoperative sore throat, I-gel, laryngeal mask airway, general anesthesia

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Analgesic Effect of Continuous Intercostal Nerve Block Infusion Compared to Continuous Thoracic Epidural Analgesia

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA ◽

10.2199/jjsca.30.980 ◽

2010 ◽

Vol 30 (7) ◽

pp. 980-985

Author(s):

Shigeyuki SAITO

Keyword(s):

Epidural Analgesia ◽

Nerve Block ◽

Analgesic Effect ◽

Intercostal Nerve ◽

Thoracic Epidural Analgesia ◽

Intercostal Nerve Block ◽

Thoracic Epidural

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Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2020.19104 ◽

2020 ◽

Vol 28 (2) ◽

pp. 257-263 ◽

Cited By ~ 1

Author(s):

Dilek Altun

Keyword(s):

Atrial Septal Defect ◽

Nerve Block ◽

Analgesic Effect ◽

Pediatric Patients ◽

Septal Defect ◽

Intercostal Nerve ◽

Defect Closure ◽

Intercostal Nerve Block ◽

Atrial Septal Defect Closure ◽

Mini Thoracotomy

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Thoracic Epidural Anesthesia for Coronary Bypass Surgery Affects Autonomic Neural Function and Arrhythmias

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.gim.0000198517.54063.74 ◽

2005 ◽

Vol 1 (2) ◽

pp. 83-87 ◽

Cited By ~ 5

Author(s):

Noriyoshi Yashiki ◽

Go Watanabe ◽

Shigeyuki Tomita ◽

Satoru Nishida ◽

Tamotsu Yasuda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

General Anesthesia ◽

Sympathetic Activity ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Thoracic Epidural ◽

Group A ◽

Group B

Background In recent years, the invasiveness of coronary reconstruction has been markedly reduced. Awake off-pump coronary artery bypass (AOCAB), coronary bypass surgery with thoracic epidural anesthesia (TEA) without general anesthesia and cardiopulmonary bypass), has been reported in the literature. Because the details of this technique are still unclear, we evaluated its usefulness by examining the autonomic neural state and the incidence of arrhythmia. Methods Fifty-five patients who underwent elective coronary artery bypass grafting (CABG) between April and December 2003 were included in the study. Patients who underwent CABG under high TEA alone comprised group A, those who underwent CABG under general anesthesia combined with TEA comprised group B, and those who underwent CABG under general anesthesia alone comprised group C. Holter electrocardiography was performed before and after surgery, and perioperative electrocardiograms were recorded (before surgery and during surgery, postoperative days 0–3, and postoperative day 7). On obtained electrocardiograms, the autonomic neural state was evaluated by analysis of heart rate variability, and the incidence of atrial fibrillation. Results Concerning the autonomic neural state, sympathetic inhibition was observed during TEA in both groups A and B. After discontinuation of TEA, sympathetic activity recovered. Vagal activity was not inhibited in group A, but decreased during surgery and gradually recovered after surgery in group B. Evaluation of the balance between sympathetic and vagal activities showed that sympathetic activity became predominant rapidly on postoperative day 2 in group B but gradually after surgery in group A. The incidence of postoperative atrial fibrillation was the highest in group B. Conclusions In AOCAB, because there is no vagal inhibition, vagal dominance can be maintained after surgery. This may be associated with the lower incidence of postoperative atrial fibrillation in group A compared with group B. Further studies are necessary to evaluate the details of AOCAB.

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