Elective Thoracotomy Research Articles

A Meta-Analysis of Ultrasound Guided Nerve Blocks for Enhanced Recovery in Adult Cardiac Surgery Patients

Background: Ultrasound-guided nerve blocks can both reduce intraoperative opioid use and pain scores. However, its role in enhancing postoperative recovery for adult cardiac patients requires further investigation. This study examines the impact of ultrasound-guided nerve block on adult cardiac patients' recovery. Methods: We conducted a systematic search for randomized controlled trials (RCTs) published between 2018 to 2022, focusing ultrasound-guided nerve block in adult cardiac surgery. The search included Pubmed, Embase, and Cochrane databases, targeting studies on elective thoracotomy. The outcomes analyzed included postoperative extubation time, intensive care unit (ICU) stay time, and length of hospital stay (LOS), using Review Manager software (Review Manager 5.4, The Cochrane Collaboration, 2020, Beijing, China) for data synthesis and analysis. Results: Out of 26 RCTs, eight studies involving including 424 subjects were included in this meta-analysis. The results showed that ultrasound-guided nerve block significantly reduced postoperative extubation time (odds ratio [OR] = –2.16, 95% confidence interval [CI]: –3.05 to –1.26), ICU stay (OR = –1.17, 95% CI: –1.40 to –0.94), and overall hospitalization duration (OR = –0.96, 95% CI: –1.64 to –0.29). Conclusion: Ultrasound-guided nerve block significantly reduces the postoperative extubation time, ICU stay, and LOS, in adult cardiovascular surgery. These benefits contribute substantially to enhanced recovery after cardiac procedures. Registration: PROSPERO (CRD42023470545).

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 Dexmedetomidine and Ketamine in Serratus Anterior Plane Block for Postoperative Pain Control in Thoracotomy Patients: A Randomized Clinical Trial.

Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg and 0.4 cc/kg ropivacaine solution 0.25% and in the ropivacaine-dexmedetomidine (RD) group, in addition to 0.4 cc/kg ropivacaine 0.25%, dexmedetomidine 0.5 µg/kg was added. Verbal Numeric Scale (VNS), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mean arterial blood pressure (MAP) were recorded. There was no significant difference in both groups in terms of demographic information (P < 0.05). The average VNS was lower in the ketamine group than in the dexmedetomidine group; however, there was a significant difference only at 1, 12, and 24 hours after surgery (P < 0.05). There was no statistically significant difference between the two groups in terms of SBP and DBP, HR, and MAP. There was a significant difference in the RR in the two groups at 12 and 24 hours after the operation (P < 0.05). Dexmedetomidine and ketamine, which were used as supplements to ropivacaine for SAPB in patients undergoing elective thoracotomy, reduced the pain intensity after thoracotomy; nevertheless, the intensity of pain reduction was more and more effective in the group receiving ketamine.

Effectiveness of autologous fibrin glue in preventing post-thoracotomy air leaks: a randomized controlled trial.

Post-thoracotomy air leaks remain a significant challenge in thoracic surgery. This randomized controlled trial assessed the efficacy of autologous fibrin glue in reducing air leaks following thoracotomy procedures. Conducted as a single-center, single-blind, randomized clinical trial, the study enrolled adult patients undergoing lung resection or decortication at a thoracic surgery clinic. Participants were randomly assigned to either the intervention group, receiving autologous fibrin glue application during surgery, or the control group, undergoing standard surgical procedures without glue application. Key inclusion criteria were adult patients undergoing elective thoracotomy for lung resection or decortication, while exclusion criteria included patients with severe comorbidities or contraindications to fibrin glue. A total of 40 patients were enrolled and randomized equally to the two groups. The group treated with autologous fibrin glue demonstrated a significant reduction in the duration of air leakage and chest tube drainage, along with a shorter hospital stay, compared to the control group. There were no statistically significant differences in postoperative complications between the groups. The application of autologous fibrin glue during thoracotomy procedures significantly reduces postoperative air leaks and hospitalization duration without increasing complication rates. This finding suggests a beneficial role of fibrin glue in thoracic procedures requiring lung resection or decortication.

The effects of erector spinae plane block (ESPB) on surgery-related stress response in thoracic surgery

Background Surgical injury induces a stress response to surgery that induces tissue repair with the activation of endocrine, metabolic, and immunological mediators aimed at restoring hemostasis. Objective In our study to determine the effect of analgesic method on postoperative respiratory function tests, stress hormone and proinflammatory response in patients undergoing elective thoracotomy surgery. Methods Seventy-two patients aged between 18 and 75 years with scheduled for elective thoracotomy surgery were included in the study. Thirty-six patients who underwent Erector Spinae Plane block were included in the block group, and 36 patients were included in the control group. IL 6, TNF alpha, cortisol, CRP, insulin and blood glucose levels were measured preoperatively, at the 3rd hour after postoperative extubation and at the 24th postoperative hour. Results We observed that while IL6 and TNF alpha levels decreased in the ESPB group compared to the preoperative period, they increased insignificantly in the control group. Conclusion ESPB has a positive effect on stress hormones and proinflammatory cytokines, reduces the use of opioids and analgesics in the intraoperative and postoperative period compared to patients without block, and lower VAS scores are obtained in patients with block.

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial.

The insertion of a double-lumen tracheal tube may cause a transient but more intense sympathetic response. We examined the effects of esketamine vs. dexmedetomidine as an adjuvant to anesthesia induction to blunt double lumen tracheal (DLT) intubation induced cardiovascular stress response. In a randomized, double-blind trial, 78 adult patients scheduled for elective thoracotomy under general anesthesia requiring DLT intubation were enrolled. The patients were randomly divided into three groups: each group received one of the following drugs prior to induction of anesthesia: dexmedetomidine 0.8 µg/kg (Group A), esketamine 0.5 mg/kg (Group B), or normal saline (group C). The primary outcome was the incidence of a DLT intubation-related cardiovascular stress response, defined as an increase in mean arterial pressure or heart rate of >30% above the baseline values. The secondary outcomes were changes in hemodynamic and cardiac function. The incidence of the response to cardiovascular stress was 23.1%, 30.8%, and 65.4% in groups A, B, and C, respectively. There was a significant decrease in intubation response in groups A and B in comparison with group C (P < 0.01); however, there was no significant difference between group A and group B (P > 0.05). Following the drug infusion and the induction of anesthesia, there was a significant decrease in HR and cardiac output in group A compared with group B. In contrast, no significant differences were observed in the left ventricular ejection fraction or in stroke volume between the three groups during induction of anesthesia. Esketamine 0.5 mg/kg and dexmedetomidine 0.8 µg/kg attenuate cardiovascular stress responses related to DLT intubation. As adjuvants to etomidate induction, they do not impair cardiac function (ChiCTR1900028030).

Postoperative Pulmonary Complications in Patients Undergoing Elective Thoracotomy Versus Thoracoscopic Surgeries.

Background Postoperative pulmonary complications correlate highly with thoracic surgery compared to other surgeries. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical approach that provides considerable advantages over major open thoracotomy. Methodology This is a retrospective cohort study. All patients aged 18 years and above of both genders were included in the study. Cases following up outside King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, were excluded from our study. Complications were measured per the records on follow-up day 1, day 7, and day 30. Mortality was measured within 30 days after the surgery. Results A total of 151 patients were included in the study. Age ranged from 18 to 85 years, with males representing 62.3% of the sample, while Saudis represented 59.6%. VATS was performed in 71.5%, while thoracotomy was performed in 28.5%. Of the total, 19.4% had postoperative complications within 30 days in the VATS group, while 23.3% were in the thoracotomy group. No significant differences were found between the rates of complications between the two groups. Additionally, the admission rate to ICU was significantly twice as common in the thoracotomy group (65.1%) compared to the VATS group (33.3%). Besides, the average duration of the chest tube's stay was three to seven days in both groups (62.1% in the VATS group and 70.7% in the thoracotomy group). Lastly, regarding the requirements of opioids, VATS showed more need for opioids (44.4%) compared to thoracotomy (32.6%). Conclusion The rates of postoperative complications were low in both groups, and no significant differences were found between the two procedures. In addition, the VATS group showed significantly higher use of opioids compared to the thoracotomy group. We recommend conducting further studies with larger sample sizes to increase the statistical power of detection.

A Clinical Comparison of 2 Bronchial Blockers Versus Double-Lumen Tubes for One-Lung Ventilation

To compare the quality of lung collapse, time, and number of attempts required to achieve lung isolation, and incidence of intraoperative malpositioning between the EZ blocker (EZB), Fuji Uniblocker (UB), and the left-sided double lumen tube (DLT). Prospective, randomized clinical trial. Single tertiary-level, university-affiliated hospital. Eighty-nine patients undergoing elective open thoracotomies or video-assisted thoracoscopic surgery. The 89 patients were randomized to receive a DLT, UB, or EZB for one-lung ventilation. The quality of lung collapse at the time of pleural opening and 10 and 20 minutes thereafter were assessed by the surgeon using the Lung Collapse Score (LCS; 0=no lung collapse to 10=best lung collapse). The time and number of attempts required to achieve lung isolation and the number of repositions required during surgery were measured. Tracheobronchial tree measurements were performed by radiologists from preoperative computed tomography imaging. The surgeon remained blinded to the type of device used. Twenty-nine patients were randomized to the DLT group and 30 patients to each of the EZB and UB groups. The LCSs among the groups at pleural opening and 10 minutes after pleural opening were not significantly different (p=0.34 and p=0.08, respectively). However, at 20 minutes after the pleural opening, the LCSs were significantly different among groups (p=0.02), with median scores being significantly lower for DLT (9 [IQR 8-9]) than for EZB (9 [IQR 9-10]; p=0.04) and UB (9.5 [IQR 9-10]; p=0.02). Lung isolation was achieved fastest in the DLT group (p < 0.01). The frequency of difficult placement did not significantly differ among groups, although it occurred most frequently in UB (n=7; 23.3%). Intraoperative repositioning also occurred most often with the UB (n=15; 50.0%). The EZB had the greatest number of cases requiring >2 repositions (n=4, 13.3%). There were no differences between preoperative airway measurements and time to isolation or incidence of intraoperative repositioning among the groups. The LCS was comparable among the 3 devices until 20 minutes after pleural opening, when better scores were obtained in the bronchial blocker groups. Lung isolation was achieved fastest with the DLT. The EZB had the highest incidence of cases requiring >2 intraoperative repositions, mostly occurring in R-sided surgery. For L-sided surgery, the EZB performed equally to the UB. This suggests that using the EZB for R-sided video-assisted thoracoscopic surgery may be suboptimal. Preoperative airway dimensions did not correlate with time to achieve isolation or incidence of intraoperative malpositioning.

Retrospective Analysis of Factors Affecting Chronic Postoperative Pain After Thoracotomy: Single Center Experience.

Despite various pain management methods, chronic pain is still a challenging issue after thoracotomy. This retrospective study was designed to determine the possible factors affecting the development of chronic pain following open thoracotomy. The study included patients who underwent elective open thoracotomy at Ankara University İbni Sina Hospital, between 01.01.2016 and 31.12.2020. The medical files and electronic records of the patients were scanned from the system. Patient history, analgesic methods, and surgical details were recorded. The need for and usage analgesic drugs after the surgery were also recorded. A total of 229 patients who underwent thoracotomy were included in the study, and 83 (36.2%) patients had chronic pain. Duration of surgery, doses of remifentanil, fentanyl or NSAI drugs, duration or number of chest tubes (more than 4 days, or more than 2 tubes), diabetes, or PCEA usage were found as variables affecting pain. Logistic Regression, Multilayer Perceptron, Naive Bayes, AdaBoost, and Random Forest methods were used to evaluate the prediction performances. According to the model created with logistic regression, the rate of the correct classification was 90.8%. The duration of surgery, remifentanil administration, chest tube for more than 4 days, and diabetes were found to be risk factors for developing chronic pain. Fentanyl bolus, PCEA-bupivacaine, and NSAID bolus were determined as preventive factors. A careful analysis of risk factors should be performed for each patient to prevent chronic pain after thoracotomy, and preemptive effective analgesia methods should be performed.

Analgesic efficacy and safety of epidural and paravertebral blocks in thoracotomy surgery

Objectives: Epidural anesthesia, once considered a gold standard, has significant complications: hypotension, urinary retention, and catastrophic neurological damage in rare cases. While paravertebral analgesia can provide similar analgesic effectiveness to epidural analgesia, it is associated with fewer side effects. To compare the perioperative and postoperative effects of epidural (ED) and ultrasound-guided paravertebral block (PVB) applications in thoracotomy surgeries. Methods: Fifty-two patients underwent elective thoracotomy; Group 1 (ED, n = 23) and Group 2 (PVB, n = 29) were evaluated. A comparison of hemodynamic parameters and complications preoperatively and postoperatively, postoperative analgesia requirements, visual analog scale (VAS) pain scores within 24 hours at specified times, the amount of analgesic used, the time to mobilize, the time to discharge, and the VAS values measured at three months was made. Results: There was no difference between the study groups regarding demographic and ASA values, most comorbid chronic diseases, obesity, and smoking. The number of attempts, the postoperative 2nd hour VAS score, and the doses of paracetamol and tramadol used was significantly higher in Group 1 than in Group 2 (p = 0.002, p = 0.002, p = 0.012, and p = 0.022, respectively). There was no statistical difference between the groups in terms of postoperative 6, 12, 24 hours, and 3 months VAS scores, first mobilization and discharge, time to remove the thorax tube, intensive care (PACU) need, and perioperative and postoperative complications (p &amp;gt; 0.05). Conclusions: Ultrasound-guided PVB can be considered a safe and effective alternative to ED in thoracotomy surgery.

DYSAESTHESIA ASSOCIATED WITH THORACIC SURGERY

<h3>Introduction</h3> Chronic pain is experienced by 50% of patients following thoracic surgery. Neuropathic pain is commonly associated with dysaesthesia. Acute pain has been associated with dysaesthesia after sternotomy.(1) The aims of this study were to compare the total area of dysaesthesia after thoracic surgery on the operated with that on the contra-lateral non-operated side of the thorax and to determine whether the severity of acute postoperative pain is associated with the total area of dysaesthesia. <h3>Methods</h3> Fourteen patients admitted for elective thoracic surgery, either thoracotomy or video-assisted thoracic surgery (VATS), were recruited. Areas of dysaesthesia were identified by applying a monofilament and a needle in 1cm intervals down the anterior and posterior thorax from the level of the clavicle down to the level of the umbilicus, comparing the operated with the non-operated side as control. Areas of dysaesthesia were marked using different coloured pens then the areas were copied onto tracing paper of a known weight per area. Areas of dysaesthesia was estimated by weighing the tracing paper. Acute pain was scored using a verbal rating scale. <h3>Results</h3> There was no significant difference (p=0.101) in total area of dysaesthesia between the operated and the non-operated side [91 cm2 (Q1= 3, Q3=332); 0 cm2 (Q1=0, Q3=16)]. When comparing the total area of dysaesthesia between the operated side of the thorax, with the non-operated side of the thorax, 9 out of 14 patients (p= 0.101) had larger areas of dysaesthesia on the operated side and 4 out of 14 patients had a larger area of dysaesthesia on the non-operated side (p= 0.101). No significant correlations were found between the total area of dysaesthesia on the operated side with acute pain after inspiration (r = 0.341, p = 0.232) or at rest (r = 0.269, p = 0.352) <h3>Conclusion</h3> The difference in total area of dysaesthesia was not significantly different between the operated and non-operated sides of the thorax. The unexpected finding of areas of dysaesthesia on the non-operated side that was acting as control inflated the risk of Type II error. Unlike after sternotomy, no significant correlation was found between acute pain and the total area of dysaesthesia.

AN UNUSUAL CULPRIT FOR EXERTIONAL DYSPNEA

AN UNUSUAL CULPRIT FOR EXERTIONAL DYSPNEA

Traumatic Haemothorax: Diagnostic approaches and surgical management

Background: Traumatic haemothorax is a collection of blood within the pleural cavity due to a penetrating or blunt injury leading to blood accumulation inside the pleural space with its respiratory and hemodynamic consequences. Objectives: Is to retrospectively study eighty victims of traumatic haemothorax regarding their age, gender, types of injury, and their sequel, as well as the methods of investigation, treatment modality (conservative or operative) and their outcome. Patients and methods: The data of 80 patients with traumatic haemothorax admitted to Ibn AL-Nnafees teaching hospital from (1st of August 2018 to 30th. of September 2019), was collected. The data was analyzed according to age, gender, clinical features, associated findings, mechanism of injury, imaging, procedure performed, operative finding, post-operative outcome, morbidity, mortality and follow up. Result: Seventy-four (92.5%) of our patients were males, and 32 (40%) were between 21-30 year of age. Fifty-four patients (67.5%) were injured by bullet, stab or shell injury. The remaining 26 patients (32.5%) were affected by blunt injury. Sixty patients (75%) were treated successfully with tube thoracostomy only. Eight patients (10%) required emergency thoracotomy after the insertion of chest tube, ten patients (12.5%) needed elective thoracotomy for (clotted haemothorax, foreign body extraction or empyema), and the remaining two patients (2.5%) presented with minimal haemothorax and didn’t need any intervention. Sixty-two of our patients (77.5%) were discharged well within 7 days. Those with air leak or who needed thoracotomy (elective or emergency) had longer hospitalization periods. Only one patient with empyema needed to stay more than 30 days. Sixty-nine (86.3%) of our patients were discharged well, while complication occurred in three patients (3.8%) with air leak, two (2.5%) ended with empyema and four patients (5%) with clotted haemothorax. Two patients (2.5%) died due to sever uncontrolled bleeding. Conclusion: Most of the patients with traumatic haemothorax were simply managed by tube thoracostomy only. In haemodynamically unstable patients, no time should be wasted for investigations and a resuscitative thoracotomy can save the patient’s life. Rapid assessment and early intervention will save the life of patient with traumatic haemothorax.

A Randomised Control Study Comparing C-MAC D-Blade Video Laryngoscope (Hyper Angulated Blade) and Macintosh Laryngoscope for Insertion of a Double-Lumen Tube in Patients Undergoing Elective Thoracotomy.

The use of a double-lumen endotracheal tube is one of the common anesthetic techniques for operations in the thoracic cavity. However, when compared to a single-lumen tube, placement of a double-lumen tube is technically more difficult as a result of which it takes more time to insert and is associated with more complications such as mucosal injury, hoarseness, and sore throat, even in patients with no anticipated airway difficulty. The CMAC D-blade that is usually used in patients with anticipated airway difficulty, could assist in smooth and quick placement of double-lumen tube (DLT) even in patients with no anticipated airway difficulty. This study aimed to evaluate the effectiveness of the C-MAC D-blade in reducing the time taken to visualize the glottis and intubate patients with normal airway with a double-lumen tube. This was a prospective open-label randomized control trial in a tertiary hospital. Seventy-three consenting adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective thoracotomy, were randomly allocated to receive either C-MAC D-blade (Group D) or Macintosh blade (Group M). The primary objective was to compare the time taken for visualization of the glottis and intubation. Chi-square/Fisher's exact test and t-test were used for statistical analysis. Seventy-three patients were randomized (Group D = 36; Group M = 37). Time to visualize the glottic structures (4.56 ± 2.396 s vs. 7.27 ± 4.891 s, P = 0.01) was significantly better in Group D; however, the mean intubation time was comparable (55.92 ± 18.749 s vs. 51.08 ± 15.269 s, P = 0.61). C-MAC D-blade videolaryngoscope offers a better glottic view and lesser time to visualize glottis when compared with the Macintosh laryngoscope. However, the time taken to insert the DLT after visualization was longer. We infer that there is no advantage in the routine use of C-MAC D-blade for DLT insertion in patients with no anticipated airway difficulty.

Compare the Efficacy and Safety of SAPB with Continuous Tea in Patients Undergoing Open Lung Resection

Objective: Serratus anterior plane block (SAPB) combined with continuous thoracic epidural analgesia (TEA) is the primary goal of our research. Study Design: Randomized Controlled Trial Place and Duration: Conducted at M.Islam Medical College Gujranwala/Rashid Latif Medical College Lahore, during from June 2021 to Dec 2021. Methods: There were one hundred and six patients of both genders were presented in this study. Patients were aged between 18-65 years.After obtaining written agreement, the demographics of enrolled patients were recorded, including their age, gender, and BMI.Patients were underwent for elective thoracotomy for lung cancer surgery. Patients were equally divided into two groups. A thoracic epidural catheter (10 ml levobupivacaine 0.25 percent followed by 5 ml/hour of 0.125 percent) was given to group II, and a SAPB (30 ml levobupivacaine 0.25 percent followed by 5 ml/hour of 0.125 percent) was given to group I. In order to assess pain, the researchers utilized a visual analogue scale (VAS). The post-operative results of both groups were compared to each other. The full data set was analyzed using the SPSS 24.0 edition. Results:We found majority of the patients 66 (62.3%) were males and 40 (37.7%) cases were females with mean age 50.2±4.42 years. Mean body mass index of the cases were 24.7±6.33kg/m2. In both groups majority of the patients 35 (66.03%) and 36 (67.9%) had ASA class III. Mean operative time in group I was greater 132.8±8.75 minutes as compared to group II 124.3±9.55 minutes. Mean pain score in group I was lower 40.6±5.21 as compared to group II 65.3±4.31. Mean VAS time of coughing was greater in group II of 76.7±1.44 than that of group I 66.2±7.37 cm•h. Analgesic usage was significantly reduced in group I, and the incidence of nausea and vomiting was significantly reduced, with no change in the rate of hypotension between the two groups. Conclusion: In this trial, we found that continuous SAPB was more effective than TEA in reducing postoperative pain in patients following open lung resection for cancer, andcomplications were reduced in the SAPB group. Keywords: Open Lung Resection, Analgesia, SAPB, TEA, VAS

Comparison of continuous thoracic epidural block and continuous thoracic paravertebral block for management of post thoracotomy pain: a randomised trial

Aim: Pain after thoracotomy is one of the most severe in clinical practice and more effective analgesia can be achieved by combining systemic and regional techniques. Though thoracic epidural analgesia (TEA) is the gold standard in the treatment, its application can be restricted due to side effects and contraindications. We investigated the hypothesis that thoracic paravertebral block (TPVB) reduced morphine consumption, pain scores, and side effects as much as TEA after thoracotomy.&#x0D; Material and Method: Fifty patients who underwent elective posterolateral thoracotomy were included in this study. Patients were randomly allocated into two groups as TEA (group I, n = 25) and TPVB (group II, n = 25). Postoperative consumption of patient-controlled morphine, visual analog scores (VAS), hemodynamic parameters, and side effects were collected in 72 hours. Additionally, pulmonary function tests (PFT) values were recorded.&#x0D; Results: Postoperative VAS values during rest were comparable between the groups (p &gt; 0.005) and they did not have significantly difference postoperative VAS values during coughing (p &gt; 0.005). The cumulative morphine consumption was higher in Group 2 (p &lt; 0.05). Side effects were comparable between the groups II (p &gt; 0.05).&#x0D; Conclusion: We conclude that TEA provided more effective analgesia than TPVB in thoracotomy patients in the early postoperative period with comparable side effects.

Pain score and other factors affecting the postoperative discharge time of patients who underwent lung resection: a retrospective study

Aim: Many factors affect the hospitalization period of patients after surgery. One of the most important of them is postoperative pain. Our study aims to investigate the relationship between the postoperative discharge time and the postoperative 24-hour visual analog scale (VAS) pain scores of patients who underwent thoracotomy and lung resection. Additionally, we also want to identify the parameters that affect the day of discharge, VAS scores, and chest tube removal time of these patients.&#x0D; Material and Method: Data of patients who underwent elective thoracic surgery between February 2021 and August 2021 in a tertiary chest disease and thoracic surgery center were analyzed patients aged between 18 and 75 years, in the ASA I-II-III risk group, with a body mass index (BMI) in the range of 18.5-35 kg/m2, who underwent thoracotomy and resection due to lung malignancy. Following data were extracted co-morbidities, diagnoses, performed surgery, type of surgery, duration of surgery, intraoperative complications, intraoperative blood product transfusion history, postoperative advanced complications, postoperative 24-hour VAS, length of stay, and length of chest tube stay.&#x0D; Results: A total of 104 patients who underwent elective thoracotomy and lung resection under general anesthesia between February 2021 and August 2021 were included in the study. There was a positive and highly statistically significant correlation between discharge time and chest tube removal time (p &lt; 0.001). There was no statistically significant correlation between discharge times and VAS scores (p=0.553). Additionally, there was no statistically significant correlation between VAS scores and chest tube removal time. Discharge time had a low positive and statistically significant correlation with age (p=0.027), and with the duration of the operation (p &lt; 0.001). There was a low degree of negative statistically significant correlation between discharge day and BMI (p=0.017).&#x0D; Conclusion: While the prolonged chest tube withdrawal time was directly related to the longer discharge time, the VAS scores have no significant correlation with the discharge time and the chest tube removal time. Additionally, age and operation time were also found to be associated with prolonged discharge time. Prospective comprehensive studies on this subject will be useful in clarifying the factors affecting the discharge time after thoracic surgery.

Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study

Background: Post–thoracotomy pain can result not only in discomfort to the patient but also in pulmonary complications, due to ineffective coughing, which leads to retention of secretions. It can result into chronic post–thoracotomy pain in the long term. Many analgesic techniques are in use to control it, including continuous serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA). We compared the efficacy and safety of SAPB with continuous TEA in patients undergoing open lung resection.&#x0D; Methodology: This randomized, open–labeled, parallel–controlled trial was done in 60 patients aged 20 to 60 y with American Society of Anesthesiologists physical status II–III, who underwent elective thoracotomy for lung cancer surgery. Patients were randomly allocated according to analgesia either via a thoracic epidural catheter (10 ml levobupivacaine 0.25%, followed by 5 ml/h of 0.125%) or an ultrasound–guided SAPB (30 ml levobupivacaine 0.25% followed by 5 ml/h of 0.125%). Mean arterial pressure and heart rate were recorded during and after the surgery. Inj. fentanyl was used as rescue analgesia. Postoperatively VAS at rest and on coughing was used to assess the pain. Any complications were noted.&#x0D; Results: After excluding five patients, 27 and 28 patients were allocated to the TEA and SAPB groups, respectively. Intraoperatively and until 24 h after the end of surgery, the mean arterial pressure and heart rate were higher in the SAPB group than in the TEA group. Intraoperatively, the requirement for fentanyl was more in the SAPB group. Postoperatively, VAS at rest and cough were significantly higher in the SAPB group. The occurrence of nausea and vomiting, hypotension, and bradycardia were similar in the groups.&#x0D; Conclusions: In patients undergoing open lung resection for cancer, continuous serratus anterior plane block was less effective than thoracic epidural analgesia in controlling postoperative pain and presented similar adverse events.&#x0D; Key words: Serratus anterior plane block; Thoracic epidural, Continuous; Thoracotomy pain, Acute&#x0D; Abbreviations: PTP – Post–thoracotomy pain; TEA – Thoracic epidural analgesia; VAS – Visual analog scale; SAPB – Serratus anterior plane block; MAP – Mean arterial blood pressure; LA – Local anesthetics&#x0D; Preregistration: The study was registered in the institutional board ethical committee (201617026) and on www.clinicaltrials.gov (NCT03933592)&#x0D; Citation: Mostafa MM, Bakeer AH, Gamal RM. Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study. Anaesth. pain intensive care 2021;25(6):733–740 ;&#x0D; DOI: 10.35975/apic.v25i6.1692&#x0D; Received: July 09, 2021, Reviewed: October 06, 2021, Accepted: October 09, 2021

Association Between Gabapentinoids and Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery

Perioperative gabapentinoids in general surgery have been associated with an increased risk of postoperative pulmonary complications (PPCs), while resulting in equivocal pain relief. This study's aim was to examine the utilization of gabapentinoids in thoracic surgery to determine the association of gabapentinoids with PPCs and perioperative opioid utilization. A multicenter retrospective cohort study. Hospitals in the Premier Healthcare Database from 2012 to 2018. A total of 70,336 patients undergoing elective open thoracotomy, video-assisted thoracic surgery, and robotic-assisted thoracic surgery. Propensity score analyses were used to assess the association between gabapentinoids on day of surgery and the primary composite outcome of PPCs, defined as respiratory failure, pneumonia, reintubation, pulmonary edema, and noninvasive and invasive ventilation. Secondary outcomes included invasive and noninvasive ventilation, hospital mortality, length of stay, opioid consumption on day of surgery, and average daily opioid consumption after day of surgery. Overall, 8,142 (12%) patients received gabapentinoids. The prevalence of gabapentin on day of surgery increased from 3.8% in 2012 to 15.9% in 2018. Use of gabapentinoids on day of surgery was associated with greater odds of PPCs (odds ratio [OR] 1.19, 95% CI 1.11-1.28), noninvasive mechanical ventilation (OR 1.30, 95% CI 1.16-1.45), and invasive mechanical ventilation (OR 1.14, 95% CI 1.02-1.28). Secondary outcomes indicated no clinically meaningful associations of gabapentinoid use with opioid consumption, hospital mortality, or length of stay. Perioperative gabapentinoid administration in elective thoracic surgery may be associated with a higher risk of PPCs and no opioid-sparing effect.

Preparation of Goal-Oriented Nano-Liquid and Its Effect of Paravertebral Nerve Block in Hemodynamics of Patients with Thoracotomy

The aim of this study was to explore the application value of paravertebral nerve block (PVB) based on goaloriented nano-liquid in patients undergoing thoracotomy. In this study, ordinary starch granules were applied to prepare starch nano-spheres by reverse phase suspension cross-linking polymerization. Then, there is an analysis on the influence of pH value, stirring speed, and reaction time on the particle size and swelling degree of starch nano-spheres. The infrared spectroscopy, scanning electron microscope, X-ray diffraction, and laser particle size were employed to analyze the particle size, characterization, and structure of starch and nanostarch microspheres in turn. 102 patients with lung cancer undergoing elective thoracotomy were selected as the research objects and rolled into a PVB group (group A) and a goal-oriented nano-liquid combined PVB (group B). The heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output index (CI), and cardiac output (CO) changes of patients from the two groups were observed at each time point. The changes of VAS scores for pain in patients from the two groups were analyzed at quietness and cough at the 3rd hour and 6th hour after surgery, as well as the incidence of postoperative complications. The results showed that when pH = 9, rotation speed was 1,000 rpm/min, and reaction time was 1 hour, the particle size of starch nano-particles was the smallest (260.74±8.78 nm), which were spherical, and the vibration absorption peak of glycosidic bond C–O–C was about 1,000 cm−1. Moreover, there were obvious diffraction peaks at 15°, 17°, and 24°. At T1, T2, and T4, the MAP value of patients from group A was dramatically higher than the value of group B (P &lt; 0.05), and the HR value of patients in group A was also greatly higher than that of group B at T3, T2, and T1 (P &lt; 0.05). The VAS scores of patients from group A at quietness and cough at the 6th hour after surgery increased greatly in contrast to the scores of group B (P &lt; 0.05). In addition, the proportion of patients in group A with postoperative complications of hypertension, chills, restlessness, and delayed recovery was markedly higher than that of group B (P &lt; 0.05). It indicated that the goal-oriented nano-starch liquid combined with PVB had little influence on the hemodynamics of patients undergoing thoracotomy, and the postoperative VAS scores and complications were reduced.