scholarly journals Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jian Wei Tan ◽  
Jameelah Sheik Mohamed ◽  
John Kit Chung Tam
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Urinary Retention ◽  
Feasibility Study ◽  
Thoracoscopic Surgery ◽  
Early Recovery ◽  
Rescue Analgesia ◽  
Video Assisted ◽  
Pain Scores ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

Efficacy of Perioperative Administration of Intravenous Parecoxib on Postoperative Morphine Consumption after Video-Assisted Thoracoscopic Surgery

2021 ◽  
Vol 104 (11) ◽  
pp. 1836-1842
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Morphine Consumption ◽  
High Dose ◽  
Video Assisted ◽  
Significant Difference ◽  
Postoperative Morphine ◽  
Video Assisted Thoracoscopic Surgery

Background: Morphine is commonly used to relief pain after video-assisted thoracoscopic surgery (VATS), however high dose morphine is usually related with many complications. Parecoxib is a potent cyclo-oxygenase inhibitor for parenteral administration that has a role in acute pain management addition to opioid protocol. Objective: To investigate the potential benefits of intravenous parecoxib for relieving postoperative pain after VATS. Materials and Methods: The present study was a randomized controlled trial that assigned 22 patients undergoing VATS into two groups to received either parecoxib 40 mg as P group with 11 patients, or placebo using 2 mL of Normal Saline Solution as C group with 11 patients with an intravenous administration at 30 minutes prior to surgery and then 12 hours later. In the postoperative period, all patients received intravenous patient-controlled analgesia (PCA) with morphine. The primary outcome was the total morphine consumption for 24 hours postoperatively. The secondary outcomes were pain score at 2, 6, 12, and 24 hours postoperatively, using a numeric rating scale (NRS, 0 to 10) and the incidence of side effects. Results: The total morphine consumption was significantly lower in P group (26.64±4.41 mg) than C group (39.82±3.87 mg) at 24 hours postoperatively (p<0.001). The NRS pain score at rest and on coughing at 24 hours postoperatively between P group compared with C group were 1.09±1.04 versus 4.45±0.69 (p<0.001) and 2.91±0.83 versus 5.36±0.81 (p<0.001), respectively. The incidences of nausea and vomiting were found in both groups at 2, 6, and 12 hours, postoperatively, but there was no statistically significant difference between both groups (p>0.05). Other adverse events such as sedation, pruritus, dyspepsia, headache, hypotension, and respiratory depression were not found. Conclusion: Perioperative administration of parecoxib was safe and effectively decrease postoperative morphine consumption and pain score at rest and on coughing within 24 hours postoperatively after VATS. Keywords: Intravenous parecoxib; Video-assisted thoracoscopic surgery; Acute postoperative pain

A randomized trial of erector spinae plane block for analgesia after video-assisted thoracoscopic surgery

2019 ◽  
Author(s):  
Yang Jin ◽  
Xuemei Jiang ◽  
Meng Sun ◽  
Xin Lv ◽  
Zongmei Wen
Keyword(s):  
Postoperative Pain ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Secondary Outcome ◽  
Video Assisted ◽  
Erector Spinae Plane Block ◽  
The Impact ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background: Erector spinae plane block (ESPB) is a novel local nerve block technique. However, evidence regarding the impact of ESPB on postoperative pain management after video-assisted thoracoscopic surgery (VATS) is lacking. This randomized controlled trial aimed to evaluate the effect of erector spinae plane block on postoperative analgesia and intra-operative opioid consumption for video-assisted thoracoscopic surgery patients. Methods: We randomly allocated 91 participants to block with 30ml ropivacaine 0.375% (n=45), or no block without placebo or sham procedure (n=46). We analyzed results from 41 participants in each group ultimately. The primary outcome was postoperative NRS pain score. The secondary outcome was intra-operative sufentanil consumption. Postoperative QoR-40 scores and postoperative complications were also recorded. Results: Erector spinae plane block reduced the median (IQR) pain scores during postoperative 0-1h, 1-6h, 6-12h and 12-24h: 3 (3-5) vs. 6 (5-7), p<0.0001; 5 (3-5) vs. 6 (5-7), p<0.0001; 4 (3-5) vs. 6 (5-7), p<0.0001 and 4 (3-5) vs. 5 (5-7), p<0.0001, respectively. Block also reduced the mean (SD) intra-operative total sufentanil consumption and per hour, per kilogram sufentanil consumption, as well as increased the median (IQR) global QoR-40 scores on POD1. Conclusions: Erector spinae plane block can be used to reduce postoperative pain and intra-operative opioid consumption for VATS patients.

scholarly journals The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

2017 ◽  
Vol 99 (2) ◽  
pp. 129-133 ◽  
Author(s):  
A Vallance ◽  
P Tcherveniakov ◽  
C Bogdan ◽  
N Chaudhuri ◽  
R Milton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Conversion Rate ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Single Centre ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Intraoperative Conversion ◽  
Video Assisted Thoracoscopic Surgery

INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010–2012: 277/713 [38.8%], 2013–2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.

scholarly journals Incidence and Risk Factors for Chronic Postsurgical Pain Following Video-assisted Thoracoscopic Surgery: a Retrospective Study

2021 ◽  
Author(s):  
Yingying Zhang ◽  
Rong Zhou ◽  
Bailing Hou ◽  
Suhong Tang ◽  
Jing Hao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Thoracoscopic Surgery ◽  
Rescue Analgesia ◽  
Postsurgical Pain ◽  
Video Assisted ◽  
Chronic Postsurgical Pain ◽  
Severe Chronic Pain ◽  
Independent Risk Factors ◽  
Video Assisted Thoracoscopic Surgery

Abstract Backgroud: Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods: We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP.Results: 2,348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1,033 of 2,348). Within those suffering CPSP, 14.71% (n = 152 of 1,033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. According to multivariable analysis, age ＜ 65 years (OR 1.278, 95% CI 1.057-1.546, P = 0.011), female (OR 1.597, 95% CI 1.344-1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090-1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696-3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047-1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159-3.574, P = 0.013), subcutaneous emphysema of chest wall postoperative (OR 1.255, 95% CI 1.000-1.575, P = 0.050), and history of postoperative wound infection (OR 5.949, 95% CI 1.344-1.898, P < 0.001) were independent risk factors for CPSP development.Conclusions: CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration: Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24

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