Drug Design Development and Therapy,
Год журнала:
2025,
Номер
Volume 19, С. 1825 - 1838
Опубликована: Март 1, 2025
Purpose:
This
study
compares
the
analgesic
effects
of
Thoracoscopic
Direct-view
Thoracic
Paravertebral
Nerve
Block
(DTPVB)
with
those
Ultrasound-guided
(UTPVB),
providing
a
clinical
reference.
Patients
and
Methods:
Sixty-eight
patients
undergoing
three-port
video-assisted
thoracic
surgery
(VATS)
general
anesthesia
were
randomly
assigned
to
either
DTPVB
group
(Group
D,
n
=
34)
or
UTPVB
U,
34).
Both
groups
received
10
mL
injection
0.75%
ropivacaine
at
T4
T7
interspaces.
Primary
outcomes
cumulative
sufentanil
equivalents
from
start
lung
manipulation
24
hours
postoperatively,
differences
assessed
against
non-inferiority
margin
5
μg
(Δ).
Secondary
include
postoperative
pain
scores,
consumption,
patient
satisfaction,
adverse
effects,
other
related
indicators.
Results:
The
use
postoperatively
was
35.0
±
6.1
in
Group
D
33.2
5.6
no
significant
difference
(P
0.217).
minus
U)
1.8
(95%
CI
−
1.07,
4.65),
within
Postoperative
complications
similar
between
groups.
However,
associated
lower
anxiety
higher
satisfaction
(P<
0.001).
At
15
minutes
post-block,
plasma
concentrations
(P=0.024).
Conclusion:
DTPVB,
via
transmural
pleural
puncture,
non-inferior
efficacy
beginning
lungs
operation
24h
postoperatively.
provides
good
alternative,
especially
for
who
are
anxious
before
surgery,
have
difficulty
cooperating
UTPVB,
cases
where
puncture
fails.
when
using
high
ropivacaine,
greater
vigilance
toxicity
is
required.
Keywords:
paravertebral
block,
TPVB,
thoracoscopic
VATS,
management
Video-assisted
thoracoscopic
surgery
(VATS)
has
been
widely
used
as
an
alternative
for
thoracotomy,
but
the
reported
incidence
of
chronic
postsurgical
pain
(CPSP)
following
VATS
varied
widely.
The
purpose
this
study
was
to
investigate
and
risk
factors
CPSP
after
VATS.We
retrospectively
collected
preoperative
demographic,
anesthesiology,
surgical
in
a
cohort
patients
undergoing
between
January
2018
October
2020.
Patients
were
interviewed
via
phone
survey
intensity,
related
medical
treatment
3
months
VATS.
Univariate
multivariate
analysis
explore
independent
associated
with
CPSP.2348
included
our
study.
43.99%
(n
=
1033
2348).
Within
those
suffering
CPSP,
14.71%
152
1033)
moderate
or
severe
pain.
Only
15.23%
23
152)
sought
active
analgesic
therapies.
Age
<
65
years
(OR
1.278,
95%
CI
1.057-1.546,
P
0.011),
female
1.597,
1.344-1.898,
0.001),
education
level
less
than
junior
school
1.295,
1.090-1.538,
0.003),
2.564,
1.696-3.877,
consumption
rescue
analgesia
postoperative
1.248,
1.047-1.486,
0.013),
sedative
hypnotic
2.035,
1.159-3.574,
history
wound
infection
5.949,
3.153-11.223,
0.001)
development.CPSP
remains
challenge
clinic
because
half
may
develop
Trial
registration
Chinese
Clinical
Registry
(ChiCTR2100045765),
2021/04/24.
Regional Anesthesia & Pain Medicine,
Год журнала:
2024,
Номер
unknown, С. rapm - 105047
Опубликована: Янв. 11, 2024
Background
and
objectives
The
evolving
surgical
techniques
in
thoracoscopic
surgery
necessitate
the
exploration
of
anesthesiological
techniques.
This
study
aimed
to
investigate
whether
incorporating
a
continuous
erector
spinae
plane
(ESP)
block
into
multimodal
analgesia
regimen
is
non-inferior
thoracic
epidural
(TEA)
terms
quality
postoperative
recovery
for
patients
undergoing
elective
unilateral
video-assisted
surgery.
Methods
We
conducted
multicenter,
prospective,
randomized,
open-label
non-inferiority
trial
between
July
2020
December
2022.
Ninety
were
randomly
assigned
receive
either
ESP
or
TEA.
primary
outcome
parameter
was
Quality
Recovery-15
(QoR-15)
score,
measured
before
as
baseline
on
days
0,
1,
2.
Secondary
parameters
included
pain
scores,
length
hospital
stay,
morphine
consumption,
nausea
vomiting,
itching,
speed
mobilization,
urinary
catheterization.
Results
Analysis
showed
mean
QoR-15
difference
groups
versus
TEA
1
(95%
CI
−9
–12,
p=0.79)
day
–1
−11
–8,
p=0.81)
−2
−14
–11,
Conclusions
Trial
registration
number
Dutch
Register
(NL6433).
Journal of Anesthesia Analgesia and Critical Care,
Год журнала:
2024,
Номер
4(1)
Опубликована: Март 11, 2024
Abstract
In
recent
years,
there
has
been
a
growing
awareness
of
the
limitations
and
risks
associated
with
overreliance
on
opioids
in
various
surgical
procedures,
including
cardiothoracic
surgery.
This
shift
pain
management
toward
reducing
reliance
opioids,
together
need
to
improve
patient
outcomes,
alleviate
suffering,
gain
early
mobilization
after
surgery,
reduce
hospital
stay,
satisfaction
functional
recovery,
led
development
widespread
implementation
enhanced
recovery
surgery
(ERAS)
protocols.
this
context,
fascial
plane
blocks
are
emerging
as
part
multimodal
analgesic
cardiac
alternatives
conventional
neuraxial
for
thoracic
is
body
evidence
suggesting
their
effectiveness
safety
providing
relief
these
procedures.
review,
we
discuss
most
common
block
techniques
used
field
offering
comprehensive
overview
regional
anesthesia
presenting
latest
use
chest
wall
specifically
setting.
Drug Design Development and Therapy,
Год журнала:
2024,
Номер
Volume 18, С. 1189 - 1198
Опубликована: Апрель 1, 2024
Purpose:
Postoperative
nausea
and
vomiting
(PONV)
frequently
occur
in
patients
after
surgery.
In
this
study,
the
authors
investigated
whether
perioperative
S-ketamine
infusion
could
decrease
incidence
of
PONV
undergoing
video-assisted
thoracoscopic
surgery
(VATS)
lobectomy.
Patients
Methods:
This
prospective,
randomized,
double-blinded,
controlled
study
was
conducted
a
total
420
from
September
2021
to
May
2023
at
Xuzhou
Central
Hospital
China,
who
underwent
elective
VATS
lobectomy
under
general
anesthesia
with
tracheal
intubation.
The
were
randomly
assigned
either
group
or
control
group.
received
bolus
injection
0.5
mg/kg
an
intraoperative
continuous
rate
0.25
mg/kg/h.
equivalent
volume
saline.
All
equipped
patient-controlled
intravenous
analgesia
(PCIA),
0.03
mg/kg/h
μg/kg/h
sufentanil
primary
outcome
PONV.
Secondary
outcomes
included
opioid
consumption,
hemodynamics,
postoperative
pain,
adverse
events.
Results:
(9.7%)
significantly
lower
than
(30.5%).
Analysis
usage
revealed
that
remifentanil
40.0%
compared
(1414.8
μg
vs
2358.2
μg),
while
consumption
75.2%
(33.1
133.6
μg).
demonstrated
better
maintenance
hemodynamic
stability.
Additionally,
visual
analogue
scale
(VAS)
scores
on
day
1
(POD-1)
3
(POD-3)
Finally,
no
statistically
significant
difference
other
reactions
observed
between
two
groups.
Conclusion:
results
trial
indicate
can
effectively
reduce
Keywords:
S-ketamine,
vomiting,
non-opioid
analgesic,
Anaesthesia,
Год журнала:
2023,
Номер
78(8), С. 1005 - 1019
Опубликована: Апрель 24, 2023
Summary
Chronic
post‐surgical
pain
is
known
to
be
a
common
complication
of
thoracic
surgery
and
has
been
associated
with
lower
quality
life,
increased
healthcare
utilisation,
substantial
direct
indirect
costs,
long‐term
use
opioids.
This
systematic
review
meta‐analysis
aimed
identify
summarise
the
evidence
all
prognostic
factors
for
chronic
after
lung
pleural
surgery.
Electronic
databases
were
searched
retrospective
prospective
observational
studies
as
well
randomised
controlled
trials
that
included
patients
undergoing
or
reported
on
pain.
We
56
resulting
in
45
identified
factors,
which
16
pooled
meta‐analysis.
Prognostic
risk
follows:
higher
postoperative
intensity
(day
1,
0–10
score),
mean
difference
(95%CI)
1.29
(0.62–1.95),
p
<
0.001;
pre‐operative
pain,
odds
ratio
2.86
(1.94–4.21),
longer
duration
(in
minutes),
12.07
(4.99–19.16),
0.001.
decreased
intercostal
nerve
block,
0.76
(0.61–0.95)
=
0.018
video‐assisted
surgery,
0.54
(0.43–0.66)
Trial
sequential
analysis
was
used
adjust
type
1
2
errors
statistical
confirmed
adequate
power
these
factors.
In
contrast
other
studies,
we
found
age
had
no
significant
effect
there
not
enough
conclude
sex.
Meta‐regression
did
reveal
effects
any
study
covariates
Expressed
grading
recommendations,
assessment,
development
evaluations
criteria,
certainty
high
moderate
block
low
intensity.
thus
actionable
can
addressed
attempt
reduce
Anaesthesia,
Год журнала:
2024,
Номер
79(11), С. 1220 - 1236
Опубликована: Сен. 25, 2024
Summary
Background
Nearly
half
of
adult
patients
undergoing
surgery
experience
moderate
or
severe
postoperative
pain.
Inadequate
pain
management
hampers
recovery
and
function
may
be
associated
with
adverse
outcomes.
This
multidisciplinary
consensus
statement
provides
principles
that
might
aid
recovery,
which
should
applied
throughout
the
entire
peri‐operative
pathway
by
healthcare
professionals,
institutions
patients.
Methods
We
conducted
a
directed
literature
review
followed
four‐round
modified
Delphi
process
to
formulate
recommendations
for
organisations
individuals.
Results
make
period,
covering
pre‐admission;
admission;
intra‐operative;
post‐anaesthetic
care
unit;
ward;
intensive
preparation
discharge;
post‐discharge
phases
care.
also
provide
generic
clinicians
consider
pathway,
including:
assessing
facilitate
function;
use
multimodal
analgesia,
including
regional
anaesthesia;
non‐pharmacological
strategies;
safe
opioids;
protocols
training
staff
in
caring
Conclusions
hope
attention
these
their
implementation,
outcomes
having
improved.