Propensity score ‐matched outcomes after thoracic epidural or paravertebral analgesia for thoracotomy
Summary It is not known which regional analgesic technique is most effective or safest after open lung resection. We retrospectively examined outcomes in 828 patients who received thoracic epidural analgesia and 791 patients who received paravertebral block after lung resection between 2008 and 2012. We analysed outcomes for 648 patients, 324 who had each analgesic technique, matched by propensity scores generated with peri‐operative data. There were 22 out of 324 (7%) postoperative respiratory complications after thoracic epidural and 23 out of 324 (7%) after paravertebral block, p = 0.88. For any postoperative complication, there were 80 out of 324 (25%) and 78 out of 324 (24%) complications, respectively, p = 0.85. There were 17 out of 324 (5%) re‐admissions to intensive care after thoracic epidural and 17 out of 324 (5%) after paravertebral block, p> 0.99, and the number of deaths before discharge were 6 out of 324 (2%) and 4 out of 324 (1%), respectively, p = 0.53. There was no significant difference in median (IQR [range]) hospital stay after thoracic epidural or paravertebral block, 6 (5–9 [2–94]) days vs. 6 (5–9 [2–122]), respectively, p = 0.83. Our study suggests that rates of complications as well as length of hospital stay after thoracic epidural analgesia and paravertebral blockade are similar. We were unable to compare analgesic efficacy due to incomplete data.
Mohammed Aloddadi, Safar Alshahrani, Ibrahim AlnaamiJournal of Pediatric Neurosciences 2018 13(1):78-80The management of hydrocephalus represents a neurosurgical challenge. Ventriculoperitoneal (VP) shunts are usually the treatment of choice for hydrocephalus. However, when VP shunt is not an option, ventriculoatrial (VA) shunt becomes a second choice. VA shunts have special complications such as postoperative neck hematomas, shunt nephritis, and migration of the distal segment. There are two main techniques for the retrieval of migrated VA shunt: either by retrieval of the broken segment by thoracotomy, which is highly in...
LEFT VENTRICULAR ASSIST DEVICES (LVADs) increasingly have been used in the management of acute and chronic cardiac failure.1 LVADs often are implanted through a left thoracotomy incision to preserve the sternotomy approach for future cardiac transplantation.2 Thoracic epidural analgesia (TEA) and thoracic paravertebral blockade (TPVB) are the current gold standards for managing acute post-thoracotomy pain3; however, block performance and catheter removal are contraindicated in the presence of systemic heparinization due to the risk of spinal hematoma.
Purpose of review Chronic postsurgical pain (CPSP) is an important and well recognized cause of much long-term suffering, which in some cases may be preventable and affects many people living with cancer. Unfortunately, general consensus is lacking as to how best reduce the risk of developing CPSP. Recent findings Cancer is now not always a short-lived, fatal disease and is now moving towards a chronic illness. Poorly managed perioperative pain is the greatest risk factor for CPSP. Recent trials have examined preventive strategies for CPSP associated with breast surgery and thoracotomy, two operations used in cancer t...
Conclusions: In conclusion, a postoperatively administered sub-sedative dose of dexmedetomidine reduces PCA sufentanil consumption and decreases nausea. PMID: 29684994 [PubMed - as supplied by publisher]
CONCLUSIONS: We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, nul...
We present a case of inverted LAA during MIMVS and provide images from transesophageal echocardiography. PMID: 29652284 [PubMed - in process]
Conclusion PNI is more effective than SNB for ISP.
Conclusion This kinetical study not only provides a comprehensive framework and transcriptional resource in the myocardium during MI, but also sheds new light on the importance of taking thoracotomy effect and the different analytical methods into account.
Since its initial description in September 2016 , the erector spinae plane (ESP) block has garnered widespread interest amongst regional anesthesiologists. A facial plane block where local anesthetic is injected between the erector spinae muscle (ESM) and the underlying transverse process (TP), this block has been used successfully for chronic pain and perioperative analgesia in adults [1,2]. Experiences with children, however, are limited thus far [3,4]. Until now, only 2 reported cases of continuous ESP block in children exist, both in patients undergoing a thoracotomy [4,5].
We report the successful airway management in a post-laryngectomy patient with a permanent tracheostoma and a short carina-stoma distance who underwent open left thoracotomy using a fiberoptically directed Fastrach wire-reinforced silicone reusable endotracheal tube ([ETT]; Teleflex, Westmeath, Ireland) to achieve one-lung ventilation (OLV). The patient's family reviewed the case and gave a written permission to publish this report and subsequently all the images.