Analgesia In Thoracic Surgery Research Articles

Comparison of Postoperative Opioid Consumption of Paravertebral Block and Erector Spinae Plane Block After Thoracotomy: A Randomized Controlled Trial.

Background Thoracotomy is associated with severe postoperative pain. Pain developing after thoracotomy causes lung infections, inability to expel secretions, and atelectasis as a result of deep breathing. Effective management of acute pain after thoracotomy may prevent these complications. A multimodal approach to analgesia is widely employed by thoracic anesthetists using a combination of regional anesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anesthesia blockade. Nowadays, regional anesthesia techniques such as thoracic epidural paravertebral block (PVB), erector spinae plane block (ESPB), and serratus plane block are frequently used to prevent pain after thoracotomy. In this study, we compared paravertebral block with erector spinae block for pain relief after thoracotomy. Our primary aim was to determine whether there was a difference between postoperative opioid consumption and pain scores. We also compared the two regional anesthesia techniques in terms of intraoperative hemodynamic data and postoperative complications. Methodology Patients aged between 18 and 75 years with an American Society of Anesthesiology (ASA) physical status I-III and scheduled for elective thoracotomy were included in the study. Using www.randomizer.org, patients were divided into two different groups, namely, ESPB and PVB.All patients were provided with a patient-controlled analgesia device preloaded with morphine. Postoperative 24-hour morphine consumptions were recorded. Results Data from 45 patients were used in the final analyses. Morphine consumption was higher in the ESPB group than in the PVB group at 24 hours postoperatively (19.2 ± 4.26 mg and 16.2 ± 2.64 mg, respectively; p < 0.05).There was no significant difference in numerical rating scale scores both at rest and with coughing (p > 0.05). Intraoperative heart rates were similar between groups. However, mean intraoperative blood pressure was significantly lower in the PVB group at 30 minutes (p < 0.05). Nausea and vomiting were observed in two patients in the ESPB group and one patient in the PVB group. The complication of nausea and vomiting was not statistically significant between the two groups (p > 0.05). Catastrophic complications such as hematoma, pneumothorax, and local anesthetic systemic toxicity were not observed in either group. Conclusions We found that patients who underwent PVB consumed less morphine postoperatively than patients who underwent ESPB. However, we did not observe any difference in pain scores between both groups. We think that ESPB can be considered a reliable method in thoracotomy surgery due to its ease of application and the fact that the place where the block is technically performed is farther from the central structures compared to PVB.In light of the results of our study, ESPB can be used as an alternative to PVB, which has been proven as postoperative analgesia in thoracic surgery.

Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial.

Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer. In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48h post operation, and the incidence of postoperative adverse reactions were compared between the two groups. The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7min, t = - 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ2 = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = - 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48h post operation than at 2, 6, 12, and 24h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups. Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery. https://www.chictr.org.cn , identifier ChiCTR2300072005, prospectively registered on 31/05/2023.

Comparison of ultrasound-guided subtransverse process interligamentary plane block with paravertebral block for postoperative analgesia in thoracic surgery: protocol for a randomised non-inferiority trial

IntroductionThe subtransverse process interligamentary (STIL) plane block is an emerging interfascial plane block that has garnered attention for its potential to provide effective postoperative analgesia for breast and thoracic surgeries....

Ultrasound-Guided Erector Spinae Plane Block versus Serratus Anterior Plane Block as Analgesia for Thoracic Surgeries

Ultrasound-Guided Erector Spinae Plane Block versus Serratus Anterior Plane Block as Analgesia for Thoracic Surgeries

Analgesic effectiveness of serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery: a systematic review and updated meta-analysis of randomized controlled trials

BackgroundSerratus anterior plane block (SAPB) is a promising regional technique for analgesia in thoracic surgery. Till now, several randomized controlled trials (RCTs) have explored the effectiveness of SAPB for postoperative pain control in patients undergoing video-assisted thoracoscopic surgery (VATS), but the sample sizes were small and conclusions remained in controversy. Therefore, we conducted the present systematic review and meta-analysis.MethodsRCTs evaluating the analgesic performance of SAPB, comparing to control methods (no block, placebo or local infiltration anesthesia), in patients undergoing VATS were searched in PubMed, EMBASE, Web of Science and Cochrane Library from inception to December 31, 2022. Mean difference (MD) and corresponding 95% confidence interval (95%CI) were calculated for postoperative pain scores at various time points, postoperative opioid consumption and length of hospital stay. Pooled relative risk (RR) with 95%CI were calculated for the risk of postoperative nausea and vomiting (PONV) and dizziness. A random-effect model was applied.ResultsA total of 12 RCTs (837 participants) were finally included. Compared to control group, SAPB had significant reductions of postoperative pain scores at 2 h (MD = -1.58, 95%CI: -1.86 to -1.31, P < 0.001), 6 h (MD = -2.06, 95%CI: -2.74 to -1.38, P < 0.001), 12 h (MD = -1.72, 95%CI: -2.30 to -1.14, P < 0.001) and 24 h (MD = -1.03, 95%CI: -1.55 to -0.52, P < 0.001), respectively. Moreover, SAPB conferred a fewer postoperative opioid consumption (MD = -7.3 mg of intravenous morphine equivalent, 95%CI: -10.16 to -4.44, P < 0.001) and lower incidence of PONV (RR = 0.56, 95%CI: 0.41 to 0.77, P < 0.001). There was no difference between both groups regarding length of hospital stay and risk of dizziness.ConclusionSAPB shows an excellent performance in postoperative pain management in patients undergoing VATS by reducing pains scores, postoperative opioid consumption and incidence of PONV. However, due to huge heterogeneity, more well-designed, large-scale RCTs are needed to verify these findings in the future.

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Objective ‒ to explore the need for additional analgesia during surgical interventions on the respiratory organs, by evaluating the consumption of opioids in the postoperative period.Materials and methods. The data of 157 patients, who underwent open surgery for lung cancer were analyzed. Patients were divided into four groups: Multimodal analgesia group (n=39): 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours with epidural analgesia using ropivacaine 2 mg/ml (3‒14 mL/h). Thoracic epidural analgesia group (n=37): epidural analgesia: in the postoperative period – ropivacaine 2 mg/ml (3‒14 mL/h). Preemptive analgesia group (n=41): according to the concept of preemptive analgesia ‒ 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period ‒ dexketoprofen and paracetamol were administered every 8 hours. Control group (n=40): patients received dexketoprofen 50 mg and, if necessary, an opioid analgesic. Pain syndrome was assessed using a visual analog scale from 0‒100 mm.Results. The lowest average dose of morphine consumption was not statistically significantly different in the multimodal analgesia and preemptive analgesia groups (p=0.933), and was significantly lower than in the control and thoracic epidural analgesia groups.Conclusions. The use of a preventive approach to perioperative analgesia in thoracic surgery, which involves the use of paracetamol and dexketoprofen, is not statistically significantly different in terms of pain indicators and the dose and number of morphine prescriptions compared to intravenous administration of paracetamol and dexketoprofen in combination with epidural ropivacaine analgesia (p&gt;0.05).

Intrathecal morphine for postoperative analgesia in thoracic surgery: Single center experience

Amaç: Bu çalışmada kliniğimizde toraks cerrahisi uygulanan hastalarda postoperatif analjezi amaçlı intratekal morfin kullanımı ile ilgili deneyimlerimizi sunmayı amaçladık. &#x0D; Gereç ve Yöntem: Bu çalışmada Ocak 2020-Haziran 2020 tarihleri arasında toraks cerrahisi geçiren ve postoperatif analjezi amaçlı intratekal morfin uygulanan toplam 18 erişkin hastanın dosyası ve anestezi formları retrospektif olarak incelendi. Grup 1;10 mcg/kg intratekal morfin, Grup 2; 7 mcg/kg intratekal morfin uygulanan grup olarak ikiye ayrıldı. Hastaların demografik verileri, uygulanan morfin dozları, anestezi ve cerrahi süreleri, intraoperatif anestezik ajan tüketimleri, postoperatif hemodinamik verileri, ağrı düzeyleri, ek analjezik ihtiyaçları ve yan etkiler incelendi.&#x0D; Bulgular: Hastaların 12’sine (% 66,7) ideal vücut ağırlığına göre 10 mcg/kg, 6’sına (%33,3) 7 mcg/kg intratekal morfin uygulandığı tespit edildi. İntraoperatif anestezik ajan tüketimi Grup 1’de Grup 2’ye kıyasla daha düşük bulundu, ancak aradaki fark istatistiksel olarak anlamlı değildi. Postoperatif 12, 24 ve 48. saatlerde dinlenme sırasında bakılan ağrı düzeyleri Grup 1’de istatistiksel olarak daha düşük. Postoperatif 12, 18, 24 ve 48. saatlerde efor sırasında bakılan ağrı düzeyleri de Grup 1’de istatistiksel olarak daha düşük bulundu.&#x0D; Sonuç: Toraks cerrahisi hastalarında uygulanan intratekal morfin güvenli bir postoperatif analjezi seçeneğidir. Bu amaçla 10 mcg/kg dozunda uygulanan intratekal morfinin 7 mcg/kg’e göre daha etkin analjezi sağladığı kanaatindeyiz.

CHANGES IN HEMODYNAMICS INDICATORS IN THE PERIOPERATIVE PERIOD IN PATIENTS IN THORACIC SURGERY

Introduction. The covid pandemic has caused a delay in diagnosis and early detection of oncological diseases, which in the future will be accompanied by a short-term decrease in the registration of new cancer cases, and then an increase in the number of surgical interventions, including on the respiratory organs. Anesthesiological support in thoracic surgery includes perioperative control of oxygenation and hemodynamic parameters, changes in which can negatively affect the postoperative period and increase the frequency of perioperative complications. Objective: To study the specifics of the impact of various methods of perioperative anesthesia during surgeries on the respiratory organs, using the evaluation of the hemodynamics and oxygenation indicators. Materials and methods. There were included 180 patients with lung cancer who underwent thoracotomy at the Kyiv City Clinical Hospital No. 17 from 2018 to 2021 within an open noncommercial randomized controlled clinical trial. Patients were randomized into four groups. Multimodal analgesia (MA) group: according to the concept of pre-emptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours, + epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative period - ropivacaine 2 mg/ml (3-14 ml/h). Thoracic epidural anagesia (TEA) group: epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative - ropivacaine 2 mg/ml (3-14 ml/h). Preemptive analgesia (PA) group: according to the concept of preemptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours. Control (C) group: patients received dexketoprofen 50 mg intravenous and opioid analgesic intramuscularly as needed. Results. There were not observed any statistically significant differences in the groups by age, height, weight, degree of anesthetic risk (ASA), blood loss, duration and volume of surgery (p&gt;0.05). A 10-15% decrease in hemodynamics was noted after epidural support with subsequent need for infusion therapy prior to induction of general anesthesia. An increase of the frequency of manifestations of hypotension, itching at the injection site, and urinary retention were observed in the MA and TEA groups in the postoperative period. Conclusion. Epidural analgesia in thoracic surgery has a number of negative complications in the perioperative period, taking into account the lack of statistical difference (p&gt;0.05) in groups according to oxygenation indicators, the use of a multimodal approach without the use of epidural support reduces the frequency of complications at all stages of complex treatment of patients.

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

ObjectiveSerratus anterior plane block (SAPB) is a new perioperative analgesia for patients undergoing thoracic and breast surgery. The primary purpose of this systematic review and meta-analysis was to investigate whether ultrasound-guided SAPB combined with general anesthesia provides safer and more effective postoperative analgesia than general anesthesia alone or general anesthesia combined with incisional local infiltration anesthesia in patients receiving thoracic and breast surgery.MethodsWe systematically searched PubMed, Embase, Web of Science and the Cochrane Library databases for clinical randomized controlled trials (RCTs) of SAPB for postoperative analgesia in thoracic and breast surgery. The primary outcome was the postoperative pain score. Secondary outcomes included intraoperative opioid consumption, 24-h postoperative opioid consumption, time to first use of analgesics, number of patients requiring urgent additional analgesics, opioid complications (postoperative nausea, vomiting, respiratory depression, constipation, dizziness, sedation) and length of hospital stay. The risk of bias was assessed using the Cochrane method and Jadad score.ResultsA total of 29 RCTs with 1,978 patients were included. Twelve studies included thoracic surgery, and 17 studies included breast surgery. The results of the meta-analysis showed that the rest or movement pain scores of the SAPB group were significantly lower than those of the control group at each postoperative time point. In addition, morphine consumption was significantly reduced in the SAPB group at 24 h postoperatively (standardized mean differences [SMD], −2.77; 95% confidence interval [CI], −3.56 to −1.97; P &amp;lt; 0.01). Intraoperative opioid consumption was significantly reduced in the SAPB group (SMD, −0.66; 95% CI, −1.03 to −0.28; P &amp;lt; 0.01); and the number of patients requiring urgent additional pain medication postoperatively (risk ratio [RR], 0.34; 95% CI, 0.27 to 0.42; P &amp;lt; 0.01) was significantly lower; and the time to first use of analgesics was significantly longer (SMD, 3.49; 95% CI, 2.23 to 4.74; P &amp;lt; 0.01); and the incidence of postoperative nausea and vomiting (PONV) (RR, 0.43; 95% CI, 0.34 to 0.54; P &amp;lt; 0.01), constipation (RR, 0.12; 95% CI, 0.03 to 0.52; P &amp;lt; 0.01; I2 = 0), dizziness (RR, 0.24; 95% CI, 0.06 to 0.92; P &amp;lt; 0.05; I2 = 0) and sedation (RR, 0.07; 95% CI, 0.01 to 0.52; P &amp;lt; 0.01; I2 = 0) were significantly lower; the length of hospital stay was significantly shorter (SMD, −0.28; 95% CI, −0.46 to −0.09; P &amp;lt; 0.01) and the SAPB group have a significantly reduced the incidence of postoperative pain syndrome at 3 months.ConclusionsCompared with no SAPB block, ultrasound-guided SAPB provides superior postoperative analgesia by reducing postoperative pain scores, the incidence of postoperative pain syndrome at 3 months and perioperative opioid consumption in patients after thoracic and breast surgery. At the same time, SAPB reduces the incidence of side effects of opioids and shortens the length of hospital stay. SAPB can be used as a feasible technique for multimodal analgesia in the perioperative period.

A Meta-Analysis of the Effect of Serratus Anterior Plane Block after Thoracic Surgery

Context: As one of the new regional nerve block techniques, the serratus anterior plane block (SAPB) has demonstrated high potential in thoracic surgery. The present study aimed to analyze the effect of SAPB following thoracic surgery. Evidence Acquisition: Chinese and English databases were retrieved to collect clinical randomized controlled studies (RCTs) on SAPB for postoperative analgesia in thoracic surgery. Both study and control groups were operated under general anesthesia, the SAPB was performed in the study group, and the rest of the postoperative analgesic regimen was the same as that of the control group. The following indicators were evaluated: (1) resting visual analogue scale (VAS) score (4, 12, and 24 h after the surgery), (2) active VAS score (4, 12, and 24 h after the surgery), (3) postoperative nausea and vomiting (PONV), (4) Postoperative Ramsay score (4-6 hours after operation), (5) Number of patient-controlled intravenous analgesia (PCIA) compressions, and (6) Postoperative sufentanil consumption. Stata software (version 15) was used for meta-analysis. Results: The resting and active VAS scores at 4, 12, and 24 h postoperatively were lower in the study group than in the control group (P&lt; 0.05), and there was no significant difference between the two groups in Ramsay scores at 4-6 h postoperatively (P &gt;0.05). The incidence of PONV was significantly lower in the study group than in the control group (P&lt; 0.05), and the number of postoperative PCIA compressions and sufentanil consumption were significantly less in the study group than in the control group (P&lt; 0.05). Conclusion: As evidenced by the obtained results, the SAPB can enhance the postoperative analgesic effect in thoracic surgery, reduce the incidence of PONV, and decrease opioid consumption

ECONOMIC EXPENDIENCY OF PRE-EMPTIVE ANALGESIA IN PATIENTS IN THORACIC SURGERY

Introduction. According to the 2020 database of the World Health Organization, unfortunately lung cancer ranks the second place among the new cases of cancer. One of the main causes of the lung cancer is tobacco smoking. More than 20% of the adult population are daily smokers, and the tobacco epidemic tends to grow steadily. Increasing number of patients who undergoing thoracotomy contributes to the constant search for perioperative anesthesia and it’s improvement.&#x0D; Objective: to compare different methods of perioperative analgesia in thoracic surgery and to determine the most effective and cost-effective method.&#x0D; Materials and methods. There were analyzed 80 lung cancer patients who underwent open access surgery. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours, + epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative period - ropivacaine 2 mg/ml (3-14 ml/h). Group B: epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative - ropivacaine 2 mg/ml (3-14 ml/h). Group C: according to the concept of preemptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours. Group D: No pre-emptive analgesia and no epidural analgesia, morphine analgesia intravenous as needed. The severity of the pain syndrome was assessed by the numerological rating scale (NRS) after 3, 6, 12, 24, 32 hours.&#x0D; Results and discussion. There were not observed any statistically significant differences in the subgroups by age, body weight, duration of surgery and blood loss (p&gt; 0.05). Patients of the Group A had the lowest level of pain, and only one patient required additional analgesia. There were no statistically significant differences in the severity of the pain syndrome between patients of the group B and the group C at all stages of the study (p &lt;0.05). Using of the pre-emptive analgesia method with the use of the multimodal analgesia, but without the use of epidural anesthesia has the benefit in the amount of 728 hryvnias prevails.

Paravertebral Block in Thoracotomy—Comparison between Single-Shot and Catheter Methods

Aim: Thoracic paravertebral block is increasingly used as a method of postoperative analgesia in thoracic surgery. We aimed to compare two different methods of implementation: paravertebral thoracic block with a catheter placed in the epidural space, and a single injection of anesthetic at the end of surgery. Methods: We randomized 60 patients undergoing VATS, in 17 (group A) single-dose paravertebral block, and in another 21 (group B) catheter technique and postoperative infusion of local anesthetic were used, and in the latter, the control group (C) of 22 patients, analgesia was performed according to a standardized protocol with non-steroidal analgesics and opioids as needed. In all patients, in the early postoperative 48 hours, we measured the intensity of pain and opioid consumption. Results: There were no statistically significant differences between the collected preoperative data in the three groups of patients. There were no significant differences in subjective pain sensations in the early postoperative period (up to 12 hours). However, the number of opioids used was significantly lower in groups A and B compared to the control group, and in group B (with catheter technique) after the 12th to 48th hour after surgery there was almost no need for strong analgesics. Conclusion: Continuous infusion of local anesthetic in the area of the surgical incision provides much better pain relief than a single paravertebral block in the area of the incision.

Current practice of thoracic anaesthesia in Europe \u2013 a survey by the European Society of Anaesthesiology Part I \u2013 airway management and regional anaesthesia techniques

BackgroundThe scientific working group for “Anaesthesia in thoracic surgery” of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) has performed an online survey to assess the current standards of care and structural properties of anaesthesia workstations in thoracic surgery.MethodsAll members of the European Society of Anaesthesiology (ESA) were invited to participate in the study.ResultsThoracic anaesthesia was most commonly performed by specialists/board-certified anaesthetists and/or senior/attending physicians. Across Europe, the double lumen tube (DLT) was most commonly chosen as the primary device for lung separation (461/ 97.3%). Bronchial blockers were chosen less frequently (9/ 1.9%).Throughout Europe, bronchoscopy was not consistently used to confirm correct double lumen tube positioning. Respondents from Eastern Europe (32/ 57.1%) frequently stated that there were not enough bronchoscopes available for every intrathoracic operation. A specific algorithm for difficult airway management in thoracic anaesthesia was available to only 18.6% (n = 88) of the respondents. Thoracic epidural analgesia (TEA) is the most commonly used form of regional analgesia for thoracic surgery in Europe. Ultrasonography was widely available 93,8% (n = 412) throughout Europe and was predominantly used for central line placement and lung diagnostics.ConclusionsWhile certain „gold standards “are widely met, there are also aspects of care requiring substantial improvement in thoracic anaesthesia throughout Europe.Our data suggest that algorithms and standard operating procedures for difficult airway management in thoracic anaesthesia need to be established. A European recommendation for the basic requirements of an anaesthesia workstation for thoracic anaesthesia is expedient and desirable, to improve structural quality and patient safety.

Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis

The objective of this study was to determine whether erector spinae plane block (ESPB) can provide an effective analgesia for managing pain after thoracic surgery and compare the efficacy of ESPB with that of other regional analgesic techniques. Systematic review and meta-analysis of randomized controlled trials. PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched. Patients undergoing thoracic surgeries. Erector spinae plane block with local anesthetics for postoperative analgesia. Seventeen studies, including 1,092 patients, were included in the final analysis. Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] -17.49, 95% CI -26.87 to -8.12), pain score at rest (MD -0.82, 95% CI -1.31 to -0.33), and pain score at movement (MD -0.77, 95% CI -1.20 to -0.3) compared to no block. Compared with other regional blocks, various results have been observed. Although statistical results showed that ESPB is inferior to thoracic paravertebral block and intercostal nerve block and superior to serratus anterior plan block in postoperative analgesia, clinical differences remain unclear. The incidence of hematoma was lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73). Erector spinae plane block may provide effective analgesia after thoracic surgery. Compared with other techniques, it is a safer method, without clinically important differences, for postoperative pain control. Therefore, ESPB may be considered as a valuable option for postoperative pain management after thoracic surgery.

Does thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections?

Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way. Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pneumonia and other postoperative pulmonary complications.In addition, inadequate pain therapy after these procedures may lead to chronic pain. Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.

Place of the paravertebral block in post-operative analgesia in thoracic surgery

The thoracic epidural analgesia (TEA) remains the standard gold for analgesic support in thoracic surgery, there is an interesting alternative to epidural analgesia, which is the paravertebral block (PVB). The aim in our study was to assess the value of performing a PVB in the management of postoperative pain in thoracic surgery compared to TEA. Methods: 80 patients were randomized to receive either epidural analgesia (n = 38, 10 cc bupivacaine 0.5% + 10 ϒ Sufentanyl then 10 cc Bupivacain 0.1% + 10 ϒ Sufentanyl via a PCA device) or PVB analgesia loss of resistance technique (n = 40, 10 cc bupivacaine 0.5% + 10 ϒ Sufentanyl via a PCA device). All patients received standard general anesthesia. The peri-operative parameters studied include standard measurement, EVA scale at rest and mobilization, use of morphinics. Results: there is a significant difference between the two groups and the incidents of puncture were significantly more important for the APDT group. The postoperative pain assessment by EVA did not show a significant difference between TEA and PVB Conclusion: the comparison of PVB to TPDA did not find significant difference in the efficacy of analgesia and the side effects. The BPV could be proposed as a first intention for postoperative analgesia in thoracic surgery.

Erector spine plane block as postoperative rescue analgesia in thoracic surgery.

Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series. We report our experience in rescue analgesia after thoracic surgery. During the postoperative stay, numeric rating scale (NRS) score >3 and inability to perform physiotherapy or effective cough due to postoperative pain represented the criteria for proposing rescue analgesia with ESPB. NRS at rest and during movements was recorded; blood gas analysis and spirometry were performed to evaluate PaO2/FiO2 (P/F), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) before ESPB execution. After performing the ESPB, static and dynamic NRS, P/F, and FVC and FEV1 were recorded at 40 minutes and 80 minutes. NRS had a reduction at rest and in dynamic assessment. The P/F did not improve but spirometric measures improved. FVC had a relevant improvement only after 80 minutes; FEV1 was increased after 40 minutes. The use of ESPB as postoperative rescue analgesia can offer several advantages due to effective rescue analgesia and safety that makes it easy to perform in the thoracic surgical ward or in an outpatient clinic setting.

Efficacy of programmed intermittent bolus epidural analgesia in thoracic surgery: a randomized controlled trial

BackgroundContinuous epidural infusion (CEI) has some disadvantages, such as increased local anesthetic consumption and limited area of anesthetic distribution. Programmed intermittent bolus (PIB) is a technique of epidural anesthesia in which boluses of local anesthetic are automatically injected into the epidural space. The usefulness of PIB in thoracic surgery remains unclear. In this study, we aimed to compare the efficacies of PIB epidural analgesia and CEI in patients undergoing thoracic surgery.MethodsThis randomized prospective study was approved by the Institutional Review Board. The study included 42 patients, who were divided into CEI (n = 21) and PIB groups (n = 21). In the CEI group, patients received continuous infusion of the local anesthetic at a rate of 5.1 mL/90 min. In the PIB group, a pump delivered the local anesthetic at a dose of 5.1 mL every 90 min. The primary endpoints were the frequency of patient-controlled analgesia (PCA) and the total dose of local anesthetic until 36 h following surgery. Student’s t-test, the chi-square test, and the Mann–Whitney U test were used for statistical analyses.ResultsThe mean number of PCA administrations and total amount of local anesthetic were not significantly different between the two groups up to 24 h following surgery. However, the mean number of PCA administrations and total amount of local anesthetic at 24–36 h after surgery were significantly lower in the PIB group than in the CEI group (median [lower–upper quartiles]: 0 [0–2.5] vs. 2 [0.5–5], P = 0.018 and 41 [41–48.5] vs. 47 [43–56], P = 0.035, respectively). Hypotension was significantly more frequent in the PIB group than in the CEI group at 0–12 h and 12–24 h (3.3% vs. 0.5%, P = 0.018 and 7.9% vs. 0%, P = 0.017, respectively).ConclusionPIB can reduce local anesthetic consumption in thoracic surgery. However, it might result in adverse events, such as hypotension.Trial registrationThis randomized prospective study was approved by the Institutional Review Board (IRB No. 15-9-06) of the Fukuoka University Hospital, Fukuoka, Japan, and was registered in the clinical trials database UMIN (ID 000019904) on 24 November 2015. Written informed consent was obtained from all patients.

Progresses in the study of serratus anterior plane block in postoperative analgesia in thoracic surgery

Serratus anterior plane(SAP) block is a simple and practical regional nerve block technique. After thoracic surgery, it provides effective analgesia for chest wall. Ultrasound-guided visualization technology further improves the success rate of block and reduces the series of complications caused by incomplete analgesia. This article reviews the recent studies on ultrasamd-guided SAP block at home and abroad, and summarizes its anatomical basis, specific block area and clinical application, so as to provide reference for clinical application. Key words: Analgesia; Serratus anterior plane block; Thoracic surgery

P05-5 - Erector spinae plane block for multimodal analgesia in thoracic surgery: a two-center case series

P05-5 - Erector spinae plane block for multimodal analgesia in thoracic surgery: a two-center case series