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.
Publication date: Available online 17 August 2018Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Hilary P. Grocott
Video-assisted mitral valve repair (VA-MVR) now is used extensively in valvular cardiac surgery.1 Despite being minimally invasive, right lateral thoracotomy VA-MRVs often induce postoperative pain.2 First described in 2013, the serratus plane block (SPB), a novel type of thoracic nerve block,3 increasingly has been employed as an effective and safe means to manage postoperative pain after VA-MVR.4
Acta Anaesthesiologica Scandinavica, EarlyView.
Conclusions We propose that the serratus plane block is a simple procedure that provides good perioperative analgesia for infant thoracotomy, potentially facilitating early extubation and a shorter hospital stay.
This article aims to review the recent advances in minimally invasive thoracic surgery. PMID: 30026975 [PubMed]
The optimal regional technique for minimally invasive direct coronary artery bypass (MIDCAB) has yet to be determined. The aim of this study was to compare the efficacy of ultrasound-guided serratus anterior plane block (SAPB) with paravertebral block (PVB) and no block for controlling acute thoracotomy pain after robotic-assisted coronary artery bypass grafting (CABG).
Conclusions: These results suggest that a combined approach using MDCT-guided lipiodol marking followed by VATS is feasible and has acceptable accuracy in resection of SPNs. PMID: 29997960 [PubMed]
AbstractRobot-assisted coronary artery bypass graft [robot-assisted (coronary artery bypass grafting (CABG)] surgery is the latest treatment for coronary artery disease. However, the surgery extensively affects cardiac and pulmonary function, and the risk factors associated with peri-operative morbidity, including prolong mechanical ventilation (PMV), have not been fully examined. In this retrospective cohort study, a total of 382 patients who underwent robot-assisted internal mammary artery harvesting with mini-thoracotomy direct-vision bypass grafting surgery (MIDCABG) from 2005 to 2012 at our tertiary care hospital were...
ConclusionPNI is more effective than SNB for ISP.
Publication date: July–August 2018Source: Brazilian Journal of Anesthesiology (English Edition), Volume 68, Issue 4Author(s): Carlos Almeida, Maria João Freitas, Diogo Brandão, José Pedro AssunçãoAbstractFemale, 85 y.o., weighting 60 kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially...