1. Update on the role of paravertebral blocks for thoracic surgery: are they worth it?
作者:Daly David J , Myles Paul S
期刊:Current opinion in anaesthesiology
日期:2009-02-01
DOI :10.1097/ACO.0b013e32831a4074
PURPOSE OF REVIEW:To consider optimal analgesic strategies for thoracic surgical patients. RECENT FINDINGS:Recent studies have consistently suggested analgesic equivalence between paravertebral and thoracic epidural analgesia. Complications appear to be significantly less common with paravertebral analgesia. SUMMARY:There is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy. Important side-effects such as hypotension, urinary retention, nausea, and vomiting appear to be less frequent with paravertebral block than with thoracic epidural analgesia. Paravertebral block is associated with better pulmonary function and fewer pulmonary complications than thoracic epidural analgesia. Importantly, contraindications to thoracic epidural analgesia do not preclude paravertebral block, which can also be safely performed in anesthetized patients without an apparent increased risk of neurological injury. The place of paravertebral block in video-assisted thoracoscopic surgery is less clear.
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4区Q3影响因子: 1.9
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2. The role of local anaesthetic techniques in ERAS protocols for thoracic surgery.
作者:Crumley Seamus , Schraag Stefan
期刊:Journal of thoracic disease
日期:2018-03-01
DOI :10.21037/jtd.2018.02.48
The use of enhanced recovery after surgery (ERAS), as in other surgical specialties, is an emerging concept in cardio-thoracic surgery but there is still a lack of effective protocols to reduce the burden of surgery on the patient, shorten the period of postoperative recovery, and reduce the likelihood of chronic pain developing. The use of local anaesthetic (LA) techniques, such as thoracic epidural analgesia (TEA) and paravertebral blocks (PVB), as an adjunct to anaesthesia are considered key components, though there is little data for direct comparison of the techniques. This review aims to evaluate the role of LA techniques in a thoracic ERAS program through evidence from literature and considering aspects of clinical practice. We discuss how ERAS is adapting and evolving with the increasing use of video-assisted thoracoscopic surgery (VATS) is thoracic surgery. It also examines the advantages of multimodal, opioid-sparing analgesia in the post-operative period to minimise the inflammatory response and improve functional recovery. LA techniques within ERAS protocols have the potential to hasten recovery when managed appropriately and to their full potential.
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4区Q2影响因子: 2.1
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3. Role of Thoracic Epidural Analgesia for Thoracic Surgery and Its Perioperative Effects.
作者:El-Tahan Mohamed R
期刊:Journal of cardiothoracic and vascular anesthesia
日期:2016-09-13
DOI :10.1053/j.jvca.2016.09.010
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2区Q1影响因子: 3.9
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4. Pain and Opioid Use After Thoracic Surgery: Where We Are and Where We Need To Go.
期刊:The Annals of thoracic surgery
日期:2020-03-03
DOI :10.1016/j.athoracsur.2020.01.056
As many as one third of patients undergoing minimally invasive thoracic surgery and one half undergoing thoracotomy will have chronic pain, defined as pain lasting 2 to 3 months. There is limited information regarding predictors of chronic pain and even less is known about its impact on health-related quality of life, known as pain interference. Currently, there is a focus on decreased opioid prescribing after surgery. Interestingly, thoracic surgical patients are the least likely to be receiving opioids before surgery and have the highest rate of new persistent opioid use after surgery compared with other surgical cohorts. These studies of opioid use have identified important predictors of new persistent opioid use, but their findings are limited by failing to correlate opioid use with pain. The objectives of this invited review are to present the findings of pertinent studies of chronic pain and opioid use after thoracic surgery, "where we are," and to discuss gaps in our knowledge of these topics and opportunities for research to fill those gaps, "where we need to go."
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1区Q1影响因子: 9.1
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5. Preventing and treating pain after thoracic surgery.
作者:Gottschalk Allan , Cohen Steven P , Yang Stephen , Ochroch E Andrew
期刊:Anesthesiology
日期:2006-03-01
DOI :10.1097/00000542-200603000-00027
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2区Q1影响因子: 3.8
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6. Opioid-Free Versus Opioid-Based Anesthesia on Postoperative Pain After Thoracoscopic Surgery: The Use of Intravenous and Epidural Esketamine.
期刊:Anesthesia and analgesia
日期:2023-07-14
DOI :10.1213/ANE.0000000000006547
BACKGROUND:The effectiveness and safety of opioid-free anesthesia (OFA) regimens in distinct types of surgeries remain controversial. In this study, we investigated whether OFA could reduce the occurrence of chronic postoperative pain in patients receiving video-assisted thoracoscopic surgery (VATS). METHODS:We conducted a 2-center, randomized, controlled trial from September 2021 to January 2022. A total of 162 lung tumor patients scheduled to undergo VATS were randomly divided into an opioid-based anesthesia (OA) group and an OFA group. The OA group received general anesthesia combined with thoracic epidural block using morphine, while the OFA group received general anesthesia combined with thoracic epidural block using esketamine. Patient-controlled epidural analgesia (PCEA) was used after surgery (ropivacaine and morphine for the OA group versus ropivacaine and esketamine for the OFA group). The primary end point was chronic pain rates at 3 months after VATS, which were analyzed using a logistic regression model. The secondary end points were chronic pain rates at 6 months, acute pain rates at 24 hours and 48 hours postoperatively, postoperative side effects, and perioperative variables. RESULTS:The final analysis included 159 patients. Acute postoperative pain at 24 hours occurred in 0 of the 79 (0%) patients in the OA group and 10 of the 80 (17.5%) patients in the OFA group (odds ratio, 52.14; 95% confidence interval [CI], 6.47-420.10; P < .001). Acute postoperative pain at 48 hours occurred in 3 of the 79 (3.8%) patients in the OA group and 2 of the 80 (2.5%) patients in the OFA group (odds ratio, 2.07; 95% CI, 0.99-4.32; P = .053). In this study, none of the patients had moderate or severe pain in either group at 3 and 6 months postsurgically. Mild chronic postoperative pain at 3 months occurred in 27 of the 79 (34.2%) patients in the OA group and 14 of the 80 (17.5%) patients in the OFA group (odds ratio, 3.52; 95% CI, 1.49-8.31; P = .004). At 6 months, mild chronic pain still occurred in 23 of the 79 (29.1%) patients in the OA group and 9 of the 80 (11.3%) patients in the OFA group (odds ratio, 5.55; 95% CI, 2.01-15.33; P = .001). In addition, the OFA group included fewer patients with side effects, including nausea, vomiting, and pruritus, within 48 hours after surgery. CONCLUSIONS:Replacement of opioids by esketamine, intraoperatively as intravenous injection and epidural infusion and postoperatively as epidural infusion, reduces the incidence of mild chronic postoperative pain and side effects in patients after VATS.
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4区Q2影响因子: 1.8
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7. Pain Management in Thoracic Surgery.
作者:Marshall Kyle , McLaughlin Keleigh
期刊:Thoracic surgery clinics
日期:2020-04-29
DOI :10.1016/j.thorsurg.2020.03.001
Thoracic surgery is considered one of the most painful surgical procedures performed. Pain is mediated via several mechanisms and is affected by the surgical approach as well as patient factors. Pain after thoracic surgery can be debilitating and lead to poor outcomes, such as respiratory complications, longer hospital stays, poor quality of life, and chronic post-thoracotomy pain syndrome. A multimodal approach to postoperative pain that combines systemic and regional anesthesia has been shown to be the most effective in optimizing analgesia in these patients.
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3区Q2影响因子: 2.1
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8. Paravertebral block: cervical, thoracic, lumbar, and sacral.
作者:Boezaart André P , Lucas Stephan D , Elliott Clint E
期刊:Current opinion in anaesthesiology
日期:2009-10-01
DOI :10.1097/ACO.0b013e32832f3277
PURPOSE OF REVIEW:This article outlines the new developments around all four types of paravertebral block: cervical, thoracic, lumbar, and sacral. RECENT FINDINGS:It is emphasized that paravertebral blocks are all performed on the level of the roots of the nerves or plexuses, which are surrounded by dura mater extending from the dura mater surrounding the spinal cord. Because of this, they are all performed with essentially the same technique and they all have the same characteristics and problems associated with them, although they are called by many different names: 'cervical paravertebral' vs. 'posterior approach', 'psoas compartment' vs. 'lumbar plexus block' vs. 'lumbar paravertebral block', and so on. The knowledge that the roots are surrounded by dura and root level blocks are done just outside the dura should afford all paravertebral blocks the same respect as spinal epidural blocks because the potential of devastating complications such as intrathecal or intramedullary injection, for example, is shared. The advances in ultrasound and other novel approaches are described, yet the value of these has not been established. SUMMARY:We discuss commonality and differences between the four types of paravertebral blocks, and newer indications and concerns, especially pertaining to nerve microanatomical differences, are highlighted.
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3区Q2影响因子: 3.5
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9. A Review of the Paravertebral Block: Benefits and Complications.
期刊:Current pain and headache reports
日期:2023-06-09
DOI :10.1007/s11916-023-01118-1
PURPOSE OF REVIEW:Paravertebral nerve blocks (PVB) have experienced a surge over the past 2 decades as improved access to ultrasound has increased ease of performance. The purpose of this review is to identify recent findings with regard to PVB's uses, including benefits, risks, and recommendations. RECENT FINDINGS:PVB is reported as an effective method of analgesia both in intraoperative and postoperative applications, with novel applications showing its potential to replace general anesthesia for certain procedures. The use of PVB as a method of analgesia postoperatively has shown lower opioid usage and faster PACU discharge, when compared to alternative approaches like the intercostal nerve block, erector spinae plane block, pectoralis II block, and patient-controlled analgesia. Thoracic epidural analgesia and a serratus anterior plane block are comparable to PVB and can be used as alternatives. The incidence of adverse events is consistently reported to be very low with few new risks being identified as the use of PVB expands. While there are worthwhile alternatives to PVB, it is an excellent option to consider, particularly for higher-risk patients. For patients undergoing thoracic or breast surgery, PVB can improve opioid usage and shorten the length of stay leading to an overall positive impact on patient recovery and satisfaction. More research is needed to further expand novel applications.
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2区Q1影响因子: 3.5
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10. Ultrasound-guided thoracic paravertebral block using a transverse in-plane approach at the level of the inferior articular process: a retrospective review of complications.
期刊:Regional anesthesia and pain medicine
日期:2024-10-08
DOI :10.1136/rapm-2022-103983
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4区Q3影响因子: 1.9
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11. What is the best pain control after thoracic surgery?
作者:Goto Taichiro
期刊:Journal of thoracic disease
日期:2018-03-01
DOI :10.21037/jtd.2018.03.63
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2区Q1影响因子: 3.8
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12. Evaluation of the Determinants of Satisfaction With Postoperative Pain Control After Thoracoscopic Surgery: A Single-Center, Survey-Based Study.
作者:Siu Emily , Quick John S , Xu Xinling , Correll Darin J
期刊:Anesthesia and analgesia
日期:2019-03-01
DOI :10.1213/ANE.0000000000003756
BACKGROUND:The need to measure, compare, and improve the quality of pain management is important to patients, payers, and health care providers. Pain after thoracic surgery can be severe, and thoracoscopic approaches have not had the favorable impact on pain as anticipated. The aim of this study was to evaluate the determinants of patient satisfaction with acute pain management and the effectiveness of pain control after video-assisted thoracoscopic surgery using a modified version of the Revised American Pain Society Patient Outcome Questionnaire. METHODS:We performed a single-center, prospective, survey-based study of 300 patients who had undergone elective video-assisted thoracoscopic surgery. Patients were enrolled and completed the survey on postoperative day 1 or 2. The primary outcome variable was patient-reported satisfaction with acute postoperative pain treatment measured on a 1-4 scale. The relationship between the items on the survey and patient satisfaction was analyzed to determine the factors significantly associated with satisfaction. RESULTS:Fifty-one percent of the patients had the highest satisfaction level with pain treatment, and 4% of the patients had the lowest satisfaction level. The mean reported acceptable pain level was 3.8 ± 1.9 (numeric rating scale [NRS], 0-10). The average pain intensity score at the time of the survey was 2.8 ± 2.1 (NRS, 0-10). The median for the most pain in the prior 24 hours was 7 (NRS, 0-10; interquartile range, 5-9). Five items from the survey were significantly associated with the satisfaction level. The predictor with the highest associated odds ratio (OR) with satisfaction was the ability to participate in pain management decisions (OR, 1.45; P < .0001). Another positively associated predictor was receiving helpful information about pain treatment options (OR, 1.31; P = .002). Negatively associated predictors of patient satisfaction included level of pain intensity at time of survey (OR, 0.76; P = .002), lowest pain score in the prior 24 hours (OR, 0.70; P = .0006), and having pain interfere with sleep in the postoperative period (OR, 0.72; P = .037). CONCLUSIONS:Our findings highlight several factors associated with patient satisfaction with acute postoperative pain management. Interventions focused on achieving acceptable pain levels for the majority of the time, ensuring that patients are able to get sleep, providing patients with helpful information about their pain treatment, and, most importantly, allowing patients to participate in decisions about their pain management may improve patient satisfaction with postoperative pain management.
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1区Q1影响因子: 9.2
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13. Variation in postoperative pain management after lung surgery in the Netherlands: a survey of Dutch thoracic surgeons.
作者:Spaans Louisa N , Bousema Jelle E , van den Broek Frank J C
期刊:British journal of anaesthesia
日期:2022-01-03
DOI :10.1016/j.bja.2021.12.005
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4区Q2影响因子: 2.1
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14. Survey of Pain Management in Thoracoscopic Surgery.
作者:Morris Benjamin N , Henshaw Daryl S , Royster Roger L
期刊:Journal of cardiothoracic and vascular anesthesia
日期:2018-02-08
DOI :10.1053/j.jvca.2018.02.013
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4区Q3影响因子: 1.2
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15. Perioperative pain management in thoracic surgery: A survey of practices in Australia and New Zealand.
期刊:Anaesthesia and intensive care
日期:2023-06-20
DOI :10.1177/0310057X231172787
There are few data on current trends in pain management for thoracic surgery in Australia and New Zealand. Several new regional analgesia techniques have been introduced for these operations in the past few years. Our survey aimed to assess current practice and perceptions towards various modalities of pain management for thoracic surgery among anaesthetists in Australia and New Zealand. A 22-question electronic survey was developed and distributed in 2020 with the assistance of the Australian and New Zealand College of Anaesthetists Cardiac Thoracic Vascular and Perfusion Special Interest Group. The survey focused on four key domains-demographics, general pain management, operative technique, and postoperative approach. Of the 696 invitations, 165 complete responses were obtained, for a response rate of 24%. Most respondents reported a trend away from the historical standard of thoracic epidural analgesia, with a preference towards non-neuraxial regional analgesia techniques. If representative of anaesthetists in Australia and New Zealand more widely, this trend may result in less exposure of junior anaesthetists to the insertion and management of thoracic epidurals, potentially resulting in reduced familiarity and confidence in the technique. Furthermore, it demonstrates a notable reliance on surgically or intraoperatively placed paravertebral catheters as the primary analgesic modality, and suggests the need for future studies assessing the optimal method of catheter insertion and perioperative management. It also gives some insight into the current opinion and practice of the respondents with regard to formalised enhanced recovery after surgery pathways, acute pain services, opioid-free anaesthesia, and current medication selection.
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4区Q2影响因子: 2.1
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16. Acute pain management for video-assisted thoracoscopic surgery: an update.
作者:Kaplowitz Jeremy , Papadakos Peter J
期刊:Journal of cardiothoracic and vascular anesthesia