High Thoracic Epidural Analgesia in Cardiac Surgery: Part 2—High Thoracic Epidural Analgesia Does Not Reduce Time in or Improve Quality of Recovery in the Intensive Care Unit

2012 ◽  
Vol 26 (6) ◽  
pp. 1048-1054 ◽  
Author(s):  
Dorthe Viemose Nielsen ◽  
Rajesh Bhavsar ◽  
Jacob Greisen ◽  
Pia Katarina Ryhammer ◽  
Erik Sloth ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Improve Quality ◽  
Thoracic Epidural ◽  
Quality Of Recovery ◽  
High Thoracic Epidural

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 < 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.

scholarly journals Erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracic surgery: a study protocol for a prospective randomized open label non-inferiority trial

2021 ◽  
Author(s):  
Renee van den Broek ◽  
Seppe Koopman ◽  
Jonne Postema ◽  
Niels Verberkmoes ◽  
Ki Jinn Chin ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Thoracoscopic Surgery ◽  
Thoracic Epidural Analgesia ◽  
Erector Spinae ◽  
Thoracic Epidural ◽  
Quality Of Recovery ◽  
Video Assisted ◽  
Erector Spinae Plane Block ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background: Thoracic epidural analgesia is considered the gold standard for pain relief in video-assisted thoracoscopic surgery. This neuraxial technique blocks pain sensation by injecting local anesthetic in the epidural space near the spinal cord to block spinal nerve roots. Recently, the erector spinae plane block has been introduced as a practical alternative to the thoracic epidural. This interfascial regional anesthesia technique interrupts pain sensation by injecting local anesthetic in between the muscular layers of the thoracic wall. Several case series and three RCTs described it as an effective pain management technique in video-assisted thoracoscopic surgery. (1–5)The objective of this study is to test the hypothesis that a continuous erector spinae plane block is non-inferior in terms of the quality of recovery as measured by the Quality of Recovery-15 score compared to continuous thoracic epidural analgesia in patients undergoing elective unilateral video-assisted thoracoscopic surgery.Methods: This is a prospective randomized open label non-inferiority trial. A total of 90 adult patients undergoing video-assisted thoracoscopic surgery will be randomized 1:1 to receive either pain treatment with continuous erector spinae plane block (study group) or continuous thoracic epidural analgesia (control group). The primary endpoint is the quality of recovery as measured by the Quality of Recovery-15 score. Secondary endpoints are postoperative pain as Numerical Rating Score scores, length of hospital stay, failure of analgesic technique, postoperative morphine-equivalent consumption, itching, nausea and vomiting, total operative time, complications related to surgery, perioperative hypotension, complications related to pain treatment, duration of bladder catheterization, time of first assisted mobilization >20 meters and of mobilization to sitting in a chair. Discussion: This randomized controlled trial aims to confirm whether a continuous erector spinae plane block can equal analgesic effect as regional anesthesia technique compared with a thoracic epidural in patients undergoing video-assisted thoracoscopic surgery.

scholarly journals High Thoracic Epidural Analgesia for Cardiac Surgery: An Audit of 874 Cases

2007 ◽  
Vol 35 (3) ◽  
pp. 374-377 ◽  
Author(s):  
C. F. Royse ◽  
P. F. Soeding ◽  
A. G. Royse
Keyword(s):  
Cardiac Surgery ◽  
Epidural Analgesia ◽  
Case Series ◽  
Epidural Haematoma ◽  
Neurological Complications ◽  
Thoracic Epidural Analgesia ◽  
Thoracic Epidural ◽  
Increased Risk ◽  
High Thoracic Epidural ◽  
Pulmonary Bypass

Despite clinical use for over 10 years, high thoracic epidural analgesia for cardiac surgery remains controversial, due to a perceived increased risk of epidural haematoma resulting from anticoagulation for cardiac pulmonary bypass. There are no sufficiently large randomised studies to address this question and few large case series reported. For this reason, we conducted an audit of neurological complications related to high thoracic epidural analgesia during cardiac surgery in our institution between 1998 and end 2005. During this period 874 patients received epidural analgesia. There were no neurological complications attributable to epidural use. Our findings suggest that major neurological complications related to high thoracic epidural use during cardiac surgery are rare.

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