scholarly journals Enhanced Recovery After Surgery Programs for Laparoscopic Colorectal Resection May Not Need Thoracic Epidural Analgesia

2017 ◽  
Vol 37 (3) ◽  
pp. 1359-1364 ◽  
Keyword(s):  
Epidural Analgesia ◽  
Colorectal Resection ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Thoracic Epidural Analgesia ◽  
Laparoscopic Colorectal Resection ◽  
Thoracic Epidural

Pain Management Strategies for Thoracic Surgery

2019 ◽  
Author(s):  
Brett Weiner ◽  
Harman Boparai ◽  
Grant H. Chen
Keyword(s):  
Pain Management ◽  
Epidural Analgesia ◽  
Thoracic Surgery ◽  
Enhanced Recovery ◽  
Opioid Analgesic ◽  
Thoracic Epidural Analgesia ◽  
Anesthetic Techniques ◽  
Perioperative Morbidity ◽  
Thoracic Epidural ◽  
Regional Anesthetic

Improper management of postoperative pain following thoracic surgery can be quite debilitating and lead to a number of complications due to the multitude of comorbid conditions manifested by the population of patients undergoing these types of procedures. These can include advanced lung disease, advanced age, heart disease, renal insufficiency and obesity.¹ The source of this acute postsurgical pain is multifactorial and can include skin incisions, deep tissue injuries, thoracostomy tubes, costovertebral joint separation and rib or sternal fractures.² Benefits of effective analgesia include decreased risk of perioperative morbidity, decreased hospital stay, decreased cost and increased patient satisfaction.³ There have been numerous studies conducted to determine the best pain management regimen for control of postthoracotomy pain, however, no single technique has thus far proven to be superior. Instead, most clinicians would advocate for a multimodal approach combining regional techniques, such as thoracic epidural analgesia or paravertebral blocks, with systemic analgesic medications including a combination of cyclooxygenase (COX)-2 inhibitors, nonsteroidal anti-inflammatory drugs, opioids and other analgesic adjuncts. This chapter will examine the different analgesic options currently available and being utilized for various types of thoracic surgical procedures. This will include a review of the systemic analgesic and non-analgesic optiondis as well as regional anesthetic techniques. The chapter will conclude with a discussion of chronic post-thoracotomy pain syndrome and currently available treatments. This review contains 4 tables, and 87 references. Keywords: systemic analgesic therapy, opioid analgesic medications, regional anesthetic techniques, thoracic epidural analgesia, paravertebral analgesia, chronic post-thoracotomy pain management, Enhanced Recovery After Surgery (ERAS), intrathecal opioid analgesia, intercostal analgesia, intrapleural analgesia

Erector spinae plane and intra thecal opioid (ESPITO) analgesia in radical nephrectomy utilising a rooftop incision: novel alternative to thoracic epidural analgesia and systemic morphine: a case series

2020 ◽  
Vol 20 (4) ◽  
pp. 847-851
Author(s):  
Ashani Ratnayake ◽  
Lihxuan Goh ◽  
Lee Woolsey ◽  
Roshan Thawale ◽  
Benjamin L. Jackson ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Radical Nephrectomy ◽  
Inferior Vena ◽  
Enhanced Recovery ◽  
Vena Cava ◽  
Thoracic Epidural Analgesia ◽  
Erector Spinae ◽  
Opioid Analgesia ◽  
Thoracic Epidural ◽  
Open Radical Nephrectomy

AbstractBackgroundOpen radical nephrectomy and inferior vena cava exploration through a roof top incision involves significant peri-operative morbidity including severe postoperative pain. Although thoracic epidural analgesia provides excellent pain relief, recent trends suggest search for effective alternatives. Systemic morphine is often used as an alternative analgesic technique. However, it does not provide dynamic analgesia and can often impede recovery in patients undergoing major surgery on the abdomen. The authors present the first report of a novel analgesic regimen in this cohort with good outcomes.MethodsFive patients undergoing open radical nephrectomy and inferior vena cava exploration received erector spinae plane infusion and intra thecal opioid analgesia at a tertiary care university teaching hospital. Outcomes included dynamic analgesia, length of hospital stay and complicationsResultsFive adult patients undergoing major upper abdominal surgery, who refused thoracic epidural analgesia, received erector spinae plane infusion and intrathecal opioid analgesia. Patients reported effective dynamic analgesia, minimal use of rescue analgesia, early ambulation and enhanced recovery.ConclusionThe novel regimen that avoids both epidural analgesia and systemic morphine can be an option in enabling enhanced recovery in this cohort.

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 Thoracic epidural analgesia improves lung function in CABG patients

2005 ◽  
Vol 52 (S1) ◽  
pp. A48-A48 ◽  
Author(s):  
Paul K. Tenenbein ◽  
Doug Maguire ◽  
Roland Debrouwere ◽  
Peter C. Duke ◽  
Stephen E. Kowalski
Keyword(s):  
Lung Function ◽  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Thoracic Epidural ◽  
Cabg Patients

A comparison of parecoxib and thoracic epidural analgesia for postoperative analgesia following Nuss procedure

2015 ◽  
Vol 50 (12) ◽  
pp. 2032-2034 ◽  
Author(s):  
Wendy Yang ◽  
Yung-Ching Ming ◽  
Yi-Chuan Kau ◽  
Chia-Chih Liao ◽  
Shih-Chang Tsai ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Nuss Procedure ◽  
Thoracic Epidural
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