Thoracotomy Patients Under General Anesthesia: A Comparison on Intra-Operative Anesthetic and Analgesic Requirements, When Combined with Either Epidural Analgesia or Continuous Unilateral Paravertebral Analgesia.
Humans
Female
Male
Thoracotomy
/ methods
Prospective Studies
Middle Aged
Anesthesia, General
/ methods
Fentanyl
/ administration & dosage
Analgesia, Epidural
/ methods
Pain, Postoperative
/ prevention & control
Adult
Isoflurane
/ administration & dosage
Anesthetics, Inhalation
/ administration & dosage
Analgesics
/ therapeutic use
Aged
Nerve Block
/ methods
Journal
Annals of cardiac anaesthesia
ISSN: 0974-5181
Titre abrégé: Ann Card Anaesth
Pays: India
ID NLM: 9815987
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
received:
23
05
2023
accepted:
12
07
2023
medline:
9
5
2024
pubmed:
9
5
2024
entrez:
9
5
2024
Statut:
ppublish
Résumé
Regional analgesia is effective for post-thoracotomy pain. The primary objective of the study is to compare the intraoperative requirement of isoflurane and fentanyl between general anaesthesia (GA) with epidural analgesia and GA with paravertebral analgesia. A prospective observational comparative study was conducted on 56 patients undergoing open thoracotomy procedures. The patients were divided into two groups of 28 by assigning the study participants alternatively to each group: Group GAE - received thoracic epidural catheterization with GA, and Group GAP - received ultrasound guided thoracic paravertebral catheterization on the operative side with GA. Intraoperative requirement of isoflurane, fentanyl, postoperative analgesia, stress response, need of rescue analgesics and adverse effects were observed and analysed. 25 patients in each group were included in the data analysis. The intraoperative requirement of isoflurane (32.28 ± 1.88 vs 48.31 ± 4.34 ml; p < 0.0001) and fentanyl (128.87 ± 25.12 vs 157 ± 30.92 μg; p = 0.0009) were significantly less in the GAE group than in the GAP group. VAS scores and need of rescue analgesics and blood glucose levels were not statistically significant during the postoperative period (p > 0.05). The incidence of adverse effects was comparable except for hypotension and urinary retention which were significantly higher in the GAE group. GA with epidural analgesia resulted in significant reduction in the intraoperative consumption of isoflurane and fentanyl in comparison to GA with paravertebral analgesia. However, both the techniques were equally effective in the postoperative period.
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
Regional analgesia is effective for post-thoracotomy pain. The primary objective of the study is to compare the intraoperative requirement of isoflurane and fentanyl between general anaesthesia (GA) with epidural analgesia and GA with paravertebral analgesia.
METHODS AND MATERIAL
METHODS
A prospective observational comparative study was conducted on 56 patients undergoing open thoracotomy procedures. The patients were divided into two groups of 28 by assigning the study participants alternatively to each group: Group GAE - received thoracic epidural catheterization with GA, and Group GAP - received ultrasound guided thoracic paravertebral catheterization on the operative side with GA. Intraoperative requirement of isoflurane, fentanyl, postoperative analgesia, stress response, need of rescue analgesics and adverse effects were observed and analysed.
RESULTS
RESULTS
25 patients in each group were included in the data analysis. The intraoperative requirement of isoflurane (32.28 ± 1.88 vs 48.31 ± 4.34 ml; p < 0.0001) and fentanyl (128.87 ± 25.12 vs 157 ± 30.92 μg; p = 0.0009) were significantly less in the GAE group than in the GAP group. VAS scores and need of rescue analgesics and blood glucose levels were not statistically significant during the postoperative period (p > 0.05). The incidence of adverse effects was comparable except for hypotension and urinary retention which were significantly higher in the GAE group.
CONCLUSION
CONCLUSIONS
GA with epidural analgesia resulted in significant reduction in the intraoperative consumption of isoflurane and fentanyl in comparison to GA with paravertebral analgesia. However, both the techniques were equally effective in the postoperative period.
Identifiants
pubmed: 38722115
doi: 10.4103/aca.aca_83_23
pii: 00660469-202427010-00003
doi:
Substances chimiques
Fentanyl
UF599785JZ
Isoflurane
CYS9AKD70P
Anesthetics, Inhalation
0
Analgesics
0
Types de publication
Journal Article
Comparative Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
10-16Informations de copyright
Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.
Références
Khajavi MR, Asadian MA, Imani F, Etezadi F, Moharari RS, Amirjamshidi A. General anesthesia versus combined epidural/general anesthesia for elective lumbar spine disc surgery:A randomized clinical trial comparing the impact of the two methods upon the outcome variables. Surg Neurol Int 2013;4:105.
Casati L, Fernández-Galinski S, Barrera E, Pol O, Puig MM. Isoflurane requirements during combined general/epidural anesthesia for major abdominal surgery. Anesth Analg 2002;94:1331–7.
Ding X, Jin S, Niu X, Ren H, Fu S, Li Q. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy:An updated meta-analysis. PLoS One 2014;9:e96233.
Gulbahar G, Kocer B, Muratli SN, Yildirim E, Gulbahar O, Dural K, et al. A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg 2010;37:467–72.
O Riain SC, Donnell BO, Cuffe T, Harmon DC, Fraher JP, Shorten G. Thoracic paravertebral block using real-time ultrasound guidance. Anesth Analg 2010;110:248–5.
Dion P. The cost of anaesthetic vapours. Can J Anaesth 1992;39:633.
Kopeika U, Taivans I, Udre S, Jakusenko N, Strazda G, Mihelsons M. Effects of the prolonged thoracic epidural analgesia on ventilation function and complication rate after the lung cancer surgery. Medicina (Kaunas) 2007;43:199–207.
Hassan ME, Mahran E. Evaluation of the role of dexmedetomidine in improvement of the analgesic profile of thoracic paravertebral block in thoracic surgeries:A randomised prospective clinical trial. Indian J Anaesth 2017;61:826–31.
Blichfeldt-Eckhardt MR, Andersen C, Ørding H, Licht PB, Toft P. Shoulder pain after thoracic surgery:Type and time course, a prospective cohort study. J Cardiothorac Vasc Anesth 2017;31:147–51.
Miranda AP, de Souza HC, Santos BF, AbrãO J, Cipriano FG, de Oliveira AS, et al. Bilateral shoulder dysfunction related to the lung resection area after thoracotomy. Medicine (Baltimore) 2015;94:e1927.
Cheema SPS, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anesthesia 1995;50:118–21.
Lonnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade:Failure rate and complications. Anesthesia 1995;50:813–5.
Piraccini E, Pretto EA Jr, Corso RM, Gambale G. Analgesia for thoracic surgery:The role of paravertebral block. HSR Proc Intensive Care Cardiovasc Anesth 2011;3:157–60.
Chalam KS, Patnaik SS, Sunil C, Bansal T. Comparative study of ultrasound-guided paravertebral block with ropivacaine versus bupivacaine for post-operative pain relief in children undergoing thoracotomy for patent ductus arteriosus ligation surgery. Indian J Anaesth 2015;59:493–8.
Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016;2:CD009121.
Júnior Ade P, Erdmann TR, Santos TV, Brunharo GM, Filho CT, Losso MJ, et al. Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy:Systematic review. Braz J Anesthesiol 2013;63:433–42.
Gruber EM, Tschernko EM, Kritzinger M, Deviatko E, Wisser W, Zurakowski D, et al. The effects of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics in patients with severe chronic obstructive pulmonary disease. Anesth Analg 2001;92:1015–9.
O'Riain SC, Buggy DJ, Kerin MJ, Watson RW, Moriarty DC. Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2. Anesth Analg 2005;100:244–9.
Saloma¨ki TE, Leppa¨luoto J, Laitinen JO, Vuolteenaho O, Nuutinen LS. Epidural versus intravenous fentanyl for reducing hormonal, metabolic, and physiologic responses after thoracotomy. Anesthesiology 1993;79:672–9.
Baidya DK, Khanna P, Maitra S. Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery:A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2014;18:626–35.
Darrah DM, Griebling TL, Silverstein JH. Postoperative urinary retention. Anesthesiol Clin 2009;27:465–84.
de Bessa PR, da Costa VV, Arci EC, Fernandes Mdo C, Saraiva RA. Thoracic epidural block performed safely in anesthetized patients. A study of a series of cases. Rev Bras Anestesiol 2008;58:354–62.
Horlocker TT, Abel MD, Messick JM Jr, Schroeder DR. Small risk of serious neurologic complications related to lumbar epidural catheter placement in anesthetized patients. Anesth Analg 2003;96:1547–52.