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.
Conclusions: CTI's are a common indication for thoracic surgical management. This contemporary, national sampling demonstrates that approximately one third of identified cases were associated with a LR. These cases demonstrated a comparable morbidity and mortality with surgical DP, but shorter hospital stays. To aid in the management of these complex disease processes, early consultation of a multidisciplinary management service for these patients should be considered. Furthermore, the appropriate use of LR for infectious etiologies may lead to safer postoperative outcomes than previously thought. PMID: 30416790 [PubMed]
Conclusions: Female sex, duration of anesthesia over 164 minutes, lower paratracheal node resection and subcarinal node resection were independent risk factors related to cough in NSCLC patients after VATS. In addition, the LCQ-MC performed satisfactorily in describing the longitudinal changes in cough symptoms. PMID: 30416784 [PubMed]
This study investigates the protective role of aerobic training against cardiac IR injury and the mitochondrial dynamics as a possible mechanism.Main methodsThirty-two male Wistar rats (8-week old) were divided into a control, sham, control + IR, and training + IR groups (8 rats each). Training group was exercised aerobically on a treadmill for 8 weeks (5 days/week). After 8 weeks, anesthetized rats underwent a left thoracotomy (sham, control + IR, and training + IR groups) to access the left anterior descending coronary artery, which was occluded by a silk suture for 30 min and released for 90 mi...
REGIONAL ANESTHESIA techniques increasingly are being promoted as part of a multimodal opioid-sparing pain management strategy including for cardiac and cardiac-related surgery.1 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Kaushal et al.2 present a prospective, randomized, single-blinded study comparing 3 regional anesthesia techniques for pain management after pediatric cardiac surgery. Two fascial plane blocks, pectoralis II block and serratus anterior plane block, and intercostal nerve blocks were compared in children undergoing cardiac procedures without cardiopulmonary bypass and via a thoracotomy approach.
This study was a single-center study. From July 2016 to December 2017, all patients with lung cancer who underwent surgery in our department were enrolled into this study. Except routine preoperative examinations, lower extremity Doppler ultrasound was performed in all patients before and after surgery to determine whether there was any newly developed deep venous thrombosis (DVT). Patients did not receive any prophylactic anticoagulant therapy before and after surgery. Patients were then divided into VTE group and control group according to whether VTE occurred after operation. Baseline data, surgical related data (surger...
The aim of this study was to compare the relative efficacy of ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for the management of post-thoracotomy pain in pediatric cardiac surgery.
Conclusion: Preemptive TPVB and SAPB provide comparable levels of adequate analgesia for the first 24 h after thoracotomy. TPVB provided better analgesia after 12 h. The two procedures reduce intraoperative fentanyl and postoperative morphine consumption.
The analgesic effects of dexamethasone have been reported previously, and the present study determined the effects of preoperative dexamethasone on postoperative pain in patients who received thoracotomy.
Conclusions: TEA provided superior anaesthesia compared to PCA in our study group. Use of PCA oxycodone in postoperative pain management after open thoracotomy provides similar nociception control compared to morphine but is associated with less sedation and patients using oxycodone IVPCA require smaller doses of rescue analgesia compared to systemic morphine IVPCA. PMID: 30233861 [PubMed]
Authors: Overtchouk P, Modine T Abstract INTRODUCTION: Alternative TAVI approaches offer the possibility of valve replacement in patients ineligible to the transfemoral route. Authors provide an updated review of the existing alternative approaches. Areas covered: A systematic review of alternative approaches for TAVI was undertaken. The feasibility, safety, efficacy and technical requirements of the transapical, transaortic, transcarotid, transsubclavian and transcaval approaches have been compared. A multi-slice computed tomography is often necessary for pre-operative planning. Although the first developed, the t...