scholarly journals Thoracic epidural analgesia vs. intravenous analgesia after lung transplant

2019 ◽  
Vol 5 (2) ◽  
pp. 4
Author(s):  
Enten G ◽  
Puri S ◽  
Patel K ◽  
Stachura Z ◽  
Schwaiger E ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Epidural Analgesia ◽  
Pain Control ◽  
Lung Transplant ◽  
Total Duration ◽  
Thoracic Epidural Analgesia ◽  
Positive Pressure ◽  
Opioid Use ◽  
Thoracic Epidural ◽  
Number Of Patients

Objective: Few reports have evaluated postoperative continuous thoracic epidural analgesia on patients who received a lung transplant. This analgesic modality may facilitate extubation, early ambulation, and achieve adequate pain control with minimization of opioid use. An opioid sparing technique could minimize the side effects of opioids such as ileus, constipation, and somnolence.Methods: A retrospective chart review following local IRB approval was performed. A total of 97 patients’ charts were collected, from April 2015 to March 2017. Forty-eight patients received T6-7 epidural, and forty-nine patients received standard intravenous (IV) analgesia. Outcome measures collected included length of intensive care unit stay, total duration of hospitalization, need for reintubation or noninvasive intermittent positive pressure ventilation (NIPPV), need for IV lidocaine gtt, and total narcotics consumption during hospitalization in milligrams of morphine equivalents (MME).Results: Both groups were comparable in age, BMI, and race/gender distribution. Additionally, patient pain requirements were comparable between groups. However, a significantly smaller proportion of thoracic epidural patients required NIPPV post-operatively, (20.4%, 53.2%: p = .0015). Further, the number of patients requiring reintubation was almost halved, (12.5%, 21.3%: NS). Patients receiving thoracic epidural also experienced shorter ICU times (p = .0335) and on average, an overall reduced length of stay by six days.Conclusions: For patients undergoing lung transplant, epidural analgesia is a viable alternative to IV pain control. Further, it significantly reduced respiratory depression and length of stay in the ICU. More refined comparisons can be made by conducting a precise prospective study with a more structured protocol in place.

scholarly journals Thoracic Epidural Analgesia Improves Outcomes after Lung Transplant

2021 ◽  
Vol 40 (4) ◽  
pp. S355
Author(s):  
C. Bowles ◽  
W. Keeyapaj ◽  
J. Brodt ◽  
G. Dhillon ◽  
Y.J. Woo ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Lung Transplant ◽  
Thoracic Epidural Analgesia ◽  
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.

Thoracic Epidural versus  Intravenous Patient-controlled Analgesia after Cardiac Surgery

2006 ◽  
Vol 104 (1) ◽  
pp. 142-151 ◽  
Author(s):  
Vigdis Hansdottir ◽  
Julia Philip ◽  
Monika Fagevik Olsen ◽  
Christina Eduard ◽  
Erik Houltz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Thoracic Epidural Analgesia ◽  
Patient Controlled Analgesia ◽  
Thoracic Epidural ◽  
Quality Of Recovery ◽  
Intravenous Morphine

Background Perioperative thoracic epidural analgesia reduces stress response and pain scores and may improve outcome after cardiac surgery. This prospective, randomized trial was designed to compare the effectiveness of patient-controlled thoracic epidural analgesia with patient-controlled analgesia with intravenous morphine on postoperative hospital length of stay and patients' perception of their quality of recovery after cardiac surgery. Methods One hundred thirteen patients undergoing elective cardiac surgery were randomly assigned to receive either combined thoracic epidural analgesia and general anesthesia followed by patient-controlled thoracic epidural analgesia or general anesthesia followed by to patient-controlled analgesia with intravenous morphine. Postoperative length of stay, time to eligibility for hospital discharge, pain and sedation scores, degree of ambulation, lung volumes, and organ morbidities were evaluated. A validated quality of recovery score was used to measure postoperative health status. Results Length of stay and time to eligibility for hospital discharge were similar between the groups. Study groups differed neither in postoperative global quality of recovery score nor in five dimensions of quality of recovery score. Time to extubation was shorter (P &lt; 0.001) and consumption of anesthetics was lower in the patient-controlled thoracic epidural analgesia group. Pain relief, degree of sedation, ambulation, and lung volumes were similar between the study groups. There was a trend for lower incidences of pneumonia (P = 0.085) and confusion (P = 0.10) in the patient-controlled thoracic epidural analgesia group, whereas cardiac, renal, and neurologic outcomes were similar between the groups. Conclusions In elective cardiac surgery, thoracic epidural analgesia combined with general anesthesia followed by patient-controlled thoracic epidural analgesia offers no major advantage with respect to hospital length of stay, quality of recovery, or morbidity when compared with general anesthesia alone followed by to patient-controlled analgesia with intravenous morphine.

Long-term Pain and Activity during Recovery from Major Thoracotomy Using Thoracic Epidural Analgesia

2002 ◽  
Vol 97 (5) ◽  
pp. 1234-1244 ◽  
Author(s):  
E. Andrew Ochroch ◽  
Allan Gottschalk ◽  
John Augostides ◽  
Kathryn A. Carson ◽  
Laura Kent ◽  
...  
Keyword(s):  
Physical Activity ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Preoperative Pain ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Analgesic Regimen ◽  
Number Of Patients ◽  
Average Pain ◽  
Muscle Sparing

Background Pain following thoracotomy can persist for years with an undetermined impact on quality of life. Factors hypothesized to modulate this painful experience include analgesic regimen, gender, and type of incision. Methods A total of 157 generally healthy patients of both genders scheduled for segmentectomy, lobectomy, or bilobectomy through a posterolateral or muscle-sparing incision were randomly assigned to receive thoracic epidural analgesia initiated prior to incision or at the time of rib approximation. Pain and activity scores were obtained 4, 8, 12, 24, 36, and 48 weeks after surgery. Results Overall, there were no differences in pain scores between the control and intervention groups during hospitalization (P &gt;or= 0.165) or after discharge (P&gt;or= 0.098). The number of patients reporting pain 1 yr following surgery (18 of 85; 21.2%) was not significantly different (P = 0.122) from the number reporting preoperative pain (15 of 120; 12.5%). During hospitalization, women reported greater pain than men (worst pain, P= 0.007; average pain, P= 0.016). Women experienced fewer supraventricular tachydysrhythmias (P = 0.013) and were thus discharged earlier (P = 0.002). After discharge women continued to report greater discomfort than men (P &lt;or= 0.016), but did not differ from men in their level of physical activity (P = 0.241). Conclusions Initiation of thoracic epidural analgesia prior to incision or the use of a muscle-sparing incision did not significantly impact pain or physical activity. Although women reported significantly greater pain during hospitalization and after discharge, they experienced fewer complications, were more likely to be discharged from the hospital sooner, and were just as active after discharge as men.

scholarly journals Evaluation of early postoperative intravenous opioid rescue as a novel quality measure in patients who receive thoracic epidural analgesia: a retrospective cohort analysis and prospective performance improvement intervention

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nadav Levy ◽  
Peter Santer ◽  
Liana Zucco ◽  
Sarah Nabel ◽  
Galina Korsunsky ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Thoracic Epidural Analgesia ◽  
Sensory Level ◽  
Opioid Use ◽  
Rescue Analgesia ◽  
Thoracic Epidural ◽  
Chronic Opioid Use

Abstract Background In this study, we explored the utility of intravenous opioid rescue analgesia in the post anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. Methods We performed a retrospective analysis of all TEA placements over a three-year period at a single academic medical center in Boston, Massachusetts. The study exposure was PACU-OpResc. Primary outcome was PACU length of stay (LOS). Secondary outcomes included reasons for delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check after TEA placement. Post implementation data was collected for 7 months. Results PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07–1.34, p = 0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51–7.57, p <  0.001). PACU-OpResc had a PPV of 76.3 and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented sensory level check after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed. Conclusions This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficacy, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate sensory level checks and reduced PACU-OpResc. Trial registration not applicable.

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