Continuous surgical multi-level extrapleural block for video-assisted thoracoscopic surgery: a retrospective study assessing its efficacy as pain relief following lobectomy and wedge resection

Autor: Jan G. Jakobsson, Ulrik Sartipy, Barbro Johansson, Mark Larsson, Anders Franco-Cereceda, Anders Öwall
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
VATS surgery
Adolescent
medicine.medical_treatment
Movement
VATS lobectomy
Analgesic
030204 cardiovascular system & hematology
General Biochemistry
Genetics and Molecular Biology
03 medical and health sciences
Young Adult
0302 clinical medicine
030202 anesthesiology
medicine
Humans
Pain Management
Thoracotomy
General Pharmacology
Toxicology and Pharmaceutics
Aged
Retrospective Studies
Aged
80 and over
Pain
Postoperative
General Immunology and Microbiology
Dose-Response Relationship
Drug
business.industry
Thoracic Surgery
Video-Assisted
General Medicine
Articles
Middle Aged
Surgery
Analgesics
Opioid
Catheter
Treatment Outcome
Levobupivacaine
Video-assisted thoracoscopic surgery
Pleura
extrapleural block
Female
Self Report
business
postoperative pain
Oxycodone
medicine.drug
Wedge resection (lung)
Research Article
Zdroj: F1000Research
ISSN: 2046-1402
Popis: Background: Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain than thoracotomy; however, adequate analgesia remains vital. As part of a multi-modal postoperative analgesia, a continuous surgeon-placed extrapleural block catheter is an option. The aim of this retrospective study was to evaluate the analgesic efficacy of a continuous extrapleural block as part of a multimodal analgesic regimen after VATS in general, and VATS lobectomy and wedge resection in particular. Methods: Case records for patients having undergone VATS surgery and been provided a multi-level continuous extrapleural block with an elastomeric pump infusing levobupivacaine 2.7 mg/ml at a rate of 5 ml/h during 2015 and 2016 were reviewed. Pain (Numeric Rating Scale) at rest and mobilisation as well as opioid requirement (daily, postoperative days 0-3, as well as accumulated) were analysed. Results: In all, 454 records were reviewed: 150 wedge resections, 264 lobectomies and 40 miscellaneous cases. At rest, pain was mild median NRS rated 3-3-1-1 for postoperative day (POD) 0 to 3, during movement, pain was rated moderate during POD 0 and 1 and mild the remaining days (median NRS 4-4-3-3 for POD 0-3). The proportion of patients exhibiting mild pain at rest increased from 55% on POD 0 to 81 % on POD 3. The percentage of patients experiencing severe pain at rest decreased from 15% to 6%. Median oxycodone consumption was 10 mg per day for POD 1-3. Pain after VATS wedge resection was significantly lower at POD 1 and 3 compared to pain after VATS lobectomy. Conclusion: We found a continuous surgeon-placed extrapleural catheter block to be a valuable and seemingly safe addition to our multimodal procedure specific analgesia after VATS. Whether the efficacy of the block can be improved by increasing local anaesthetic and/or adding adjuncts warrants further investigation.
Databáze: OpenAIRE
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