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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.
Source: Anaesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research

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Purpose of review Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. Recent findings Lung resections appears to be relatively safe in the elderly patients presenting with lung cancer. Whenever possible, a lobectomy should be offered to patients with a good performance status who present with early stage disease. ...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research
THERE IS an increasing trend toward the use of minimally invasive approaches in cardiac surgery.1 Many of these utilize a thoracotomy incision, which is associated with significant acute2,3 and chronic pain.4 Regional anesthesia is commonly advocated as part of a multimodal analgesic strategy, but the first-line options of thoracic epidural analgesia and thoracic paravertebral block2 are not usually feasible in cardiac surgery, where perioperative anticoagulation and hemodynamic instability are commonplace.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Report Source Type: research
We thank Snow et al for appreciating our manuscript entitled “Effect of paravertebral dexmedetomidine on the intra-operative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome.”1 We agree that ideally data from a study involving children cannot be extrapolated to calculate sample size for a study in adults. The sample size calcula tion in our study was based on a single available study that assessed the effect of neuraxial (caudal) dexmedetomidine on inhalational anesthetics requirement.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
Purpose of review Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. Recent findings Lung resections appears to be relatively safe in the elderly patients presenting with lung cancer. Whenever possible, a lobectomy should be offered to patients with a good performance status who present with early stage disease. ...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research
Source: Anesthesiology - Category: Anesthesiology Source Type: research
We appreciate Monteset al.’s interest in our article. In their 2015 Anesthesiology article, the authors analyzed data from 2,929 patients who were candidates for inguinal hernia repair (men), hysterectomy (women), or thoracotomy (men) under general, regional, or local anesthesia with sedation. Four hundred and two patients (all male) underwent thoracotomy.1 Approximately 4.4 months after surgery, 37.6% of the thoracotomy patients had chronic postsurgical pain. We think the size of the study —nearly 3,000 patients enrolled—is quite remarkable.
Source: Anesthesiology - Category: Anesthesiology Source Type: research
ADEQUATE PAIN RELIEF has been deemed a fundamental right for patients experiencing varying degrees of pain after surgery.1 The methods of postoperative pain management continue to change over time. In patients undergoing thoracic surgery via thoracotomy, epidural analgesia has been considered an optimal technique for pain relief. Intravenous opioids have remained the mainstay for intraoperative and postoperative analgesia, in addition to various other types of nerve blocks and adjuncts,2 particularly when patients experience moderate-to-severe pain.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
To determine the incidence of ipsilateral shoulder pain (ISP) with the therapeutic use of parecoxib compared with a placebo after thoracotomy.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
The objective of this study was to evaluate the feasibility of pleural dye marking using radial-EBUS (r-EBUS) combined with virtual bronchoscopy (VB) to help minimally invasive resection of small peripheral lung nodule (SPLN) or ground glass opacities (GGOs).Methods: Both bronchial path to nodule (LungPoint Software®) and sub-pleural methylene blue deposition were performed in the operating room immediately before minimally invasive surgery. A 4 mm fiberscope with a 2mm working channel, 1.4 mm r-EBUS probe and guide sheath were used under general anesthesia without fluoroscopy guidance, in a patient on operating positi...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional Pulmonology Source Type: research
AbstractRationale:Most of the esophageal diverticulums are congenital traction instead of in childhood. In most conditions, esophageal diverticulums are free of any symptoms. As one of the rare entity, esophageal diverticulum can also result in bronchoesophageal fistula.Patient concerns:A 10-year-old girl was admitted due to a 2-month history of cough and choking after drinking, and fever for 3 days. No symptoms when taking solid food were found.Diagnoses:By esophagogram, 3-dimensional computed tomography and esophagoscopy, an esophageal diverticulum was demonstrated in the middle esophagus with a bronchoesophageal fistula...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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