scholarly journals Efficacy of Single-shot Thoracic Paravertebral Block Combined with Intravenous Analgesia Versus Continuous Thoracic Epidural Analgesia for Chronic Pain After Thoracotomy

2021 ◽  
Vol 24 (6) ◽  
pp. E753-E759
Keyword(s):  
Chronic Pain ◽  
Epidural Analgesia ◽  
Pain Intensity ◽  
Acute Pain ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Single Shot ◽  
Thoracic Paravertebral Block ◽  
Thoracic Epidural ◽  
Intravenous Analgesia

BACKGROUND: Patients undergoing thoracic surgery frequently suffer from chronic pain after thoracotomy. Chronic pain can lead to a significant decline in a patient’s quality of life. However, the effect of single-shot thoracic paravertebral block (TPVB) combined with intravenous analgesia on chronic pain incidence is unclear. OBJECTIVE: The objective was to evaluate the impact of single-shot TPVB combined with intravenous analgesia versus continuous thoracic epidural analgesia (TEA) on chronic pain incidence after thoracotomy. STUDY DESIGN: A randomized controlled study. SETTING: Hospital department in China. METHODS: Ninety-six patients undergoing thoracotomy were randomly assigned to 2 groups: single-shot TPVB combined with intravenous analgesia (Group P) and continuous TEA (Group E). The pain intensity was assessed using the Verbal Rating Scale (VRS). The outcome measures were chronic pain incidence and the acute and chronic pain intensity. RESULTS: The chronic pain incidence at rest in Group P was significantly higher than that in Group E at 3 months and 12 months postoperation (55.2% versus 28.6%, P = 0.019; 34.5% versus 14.3%, P = 0.027). The patients in Group E showed less pain intensity at rest compared with those in Group P at 3 months postoperation (0.0 versus 1.0, P = 0.034). At 6 hours and 24 hours postoperation, the acute pain intensity at coughing and at rest in Group E was lower than that in group P (VRS at coughing: 6 hours: 0.0 versus 2.0, P = 0.001; 24 hours: 3.0 versus 5.0, P = 0.010. VRS at rest: 6 hours: 0.0 versus 2.0, P = 0.000; 24 hours: 1.0versus. 2.0, P = 0.001). LIMITATIONS: An important limitation of this study is that it is not a double-blind study. CONCLUSIONS: In patients undergoing thoracotomy, continuous TEA significantly reduced the chronic pain incidence at rest at 3 months and 12 months after operation and provided better acute pain relief up to 24 hours after operation compared with single-shot TPVB combined with intravenous analgesia. KEY WORDS: Acute pain, chronic pain, thoracic paravertebral block, thoracic epidural analgesia, chronic pain prevention, thoracotomy

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.

scholarly journals Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

2014 ◽  
Vol 55 (4) ◽  
pp. 1106 ◽  
Author(s):  
Jae Hoon Lee ◽  
Jin Ha Park ◽  
Hae Keum Kil ◽  
Seung Ho Choi ◽  
Sung Hoon Noh ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Intrathecal Morphine ◽  
Thoracic Epidural Analgesia ◽  
Thoracic Epidural ◽  
Intravenous Analgesia

Patient with Postthoracotomy Pain

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

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.

scholarly journals Thoracic Epidural Analgesia and Acute Pain Management

2011 ◽  
Vol 115 (1) ◽  
pp. 181-188 ◽  
Author(s):  
Smith C. Manion ◽  
Timothy J. Brennan ◽  
Bruno Riou
Keyword(s):  
Pain Management ◽  
Epidural Analgesia ◽  
Acute Pain ◽  
Thoracic Epidural Analgesia ◽  
Acute Pain Management ◽  
Thoracic Epidural

Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial

2018 ◽  
Vol 68 (05) ◽  
pp. 410-416 ◽  
Author(s):  
Hatem A. El Shora ◽  
Ahmed A. El Beleehy ◽  
Amr A. Abdelwahab ◽  
Gaser A. Ali ◽  
Tarek E. Omran ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Epidural Analgesia ◽  
Pain Control ◽  
Controlled Trial ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Ultrasound Guided ◽  
Thoracic Epidural ◽  
Group I ◽  
Post Cardiac Surgery

Background Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. Materials and Methods Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups. Group I (n = 70 patients) had bilateral ultrasound-guided thoracic paravertebral block and Group II (n = 75 patients) had thoracic epidural analgesia. The primary end point was the postoperative visual analogue scale (VAS). The duration of mechanical ventilation, intensive care unit (ICU), and hospital stay were the secondary end points. The study design is a randomized parallel superiority clinical trial. Results Both groups had similar preoperative and operative characteristics. No significant difference in VAS measured immediately after endotracheal extubation then after 12, 24, and 48 hours between groups (p = 0.45). Pain score significantly declined with the repeated measures (p < 0.001) and the decline was not related to the treatment group. Postoperative pain was significantly related to diabetes mellitus (p = 0.039). Six patients in group I (8.5%) required an additional dose of morphine versus three patients (4%) in group II (p = 0.30). Patients in group I had significantly shorter ICU stay (p = 0.005) and lower incidence of urinary retention (p = 0.04) and vomiting (p = 0.018). No difference was found in operative complications between groups. Conclusion This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.

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