Michael Ried1, Christian Schilling2, Tobias Potzger2, Karl-Peter Ittner3, Andrea Rupp4, Tamas Szöke5, Hans-Stefan Hofmann6, Claudius Diez2. 1. Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany. Electronic address: micha.ried@t-online.de. 2. Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany. 3. Department of Anesthesiology, University Medical Center RegensburgRegensburg, Germany. 4. Department of Anaesthesiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany. 5. Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany. 6. Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany; Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
Abstract
OBJECTIVE: Pain after thoracotomy is associated with intense discomfort leading to impaired pulmonary function. DESIGN: Prospective, non-randomized trial from April 2009 to September 2011. SETTING: Department of Thoracic Surgery, single-center. PARTICIPANTS: Thoracic surgical patients. INTERVENTIONS: Comparison of thoracic epidural analgesia (TEA) with the On-Q® PainBuster® system after thoracotomy. MEASUREMENTS AND MAIN RESULTS: The TEA group (n=30) received TEA with continuous 0.2% ropivacaine at 4 mL-to-8 mL/h, whereas Painbuster® patients (n=32) received 0.75% ropivacaine at 5 mL/h until postoperative day 4 (POD4). Basic and on-demand analgesia were identical in both groups. Pain was measured daily on a numeric analog scale from 0 (no pain) to 10 (worst pain) at rest and at exercise. There were no significant differences regarding demographic and preoperative data between the groups, but PainBuster® patients had a slightly lower relative forced expiratory volume in 1 second (FEV1) (71±20% versus 86±21%; p=0.01). Most common surgical procedures were lobectomies (38.8%) and atypical resections (28.3%) via anterolateral thoracotomy. Most common primary diagnoses were lung cancer (48.3%) and tumor of unknown origin (30%). At POD1, median postoperative pain at rest was 2.1 (1; 2.8) in the TEA group and 2 (1.5; 3.8; p=0.62) in the PainBuster® group. At exercise, median pain was 4.3 (3.5; 3.8) in the TEA group compared to 5.0 (4.0; 6.5; p=0.07). Until POD 5 there were decreases in pain at rest and exercise but without significant differences between the groups. CONCLUSIONS: Sufficient analgesia after thoracotomy can be achieved with the intercostal PainBuster® system in patients, who cannot receive TEA.
OBJECTIVE:Pain after thoracotomy is associated with intense discomfort leading to impaired pulmonary function. DESIGN: Prospective, non-randomized trial from April 2009 to September 2011. SETTING: Department of Thoracic Surgery, single-center. PARTICIPANTS: Thoracic surgical patients. INTERVENTIONS: Comparison of thoracic epidural analgesia (TEA) with the On-Q® PainBuster® system after thoracotomy. MEASUREMENTS AND MAIN RESULTS: The TEA group (n=30) received TEA with continuous 0.2% ropivacaine at 4 mL-to-8 mL/h, whereas Painbuster® patients (n=32) received 0.75% ropivacaine at 5 mL/h until postoperative day 4 (POD4). Basic and on-demand analgesia were identical in both groups. Pain was measured daily on a numeric analog scale from 0 (no pain) to 10 (worst pain) at rest and at exercise. There were no significant differences regarding demographic and preoperative data between the groups, but PainBuster® patients had a slightly lower relative forced expiratory volume in 1 second (FEV1) (71±20% versus 86±21%; p=0.01). Most common surgical procedures were lobectomies (38.8%) and atypical resections (28.3%) via anterolateral thoracotomy. Most common primary diagnoses were lung cancer (48.3%) and tumor of unknown origin (30%). At POD1, median postoperative pain at rest was 2.1 (1; 2.8) in the TEA group and 2 (1.5; 3.8; p=0.62) in the PainBuster® group. At exercise, median pain was 4.3 (3.5; 3.8) in the TEA group compared to 5.0 (4.0; 6.5; p=0.07). Until POD 5 there were decreases in pain at rest and exercise but without significant differences between the groups. CONCLUSIONS: Sufficient analgesia after thoracotomy can be achieved with the intercostal PainBuster® system in patients, who cannot receive TEA.
Authors: Dawn E Jaroszewski; M'hamed Temkit; MennatAllah M Ewais; Todd C Luckritz; Joshua D Stearns; Ryan C Craner; Brantley D Gaitan; Harish Ramakrishna; Christopher A Thunberg; Ricardo A Weis; Kelly M Myers; Marianne V Merritt; David M Rosenfeld Journal: J Thorac Dis Date: 2016-08 Impact factor: 2.895
Authors: Jelle E Bousema; Esther M Dias; Sander M Hagen; Bastiaan Govaert; Patrick Meijer; Frank J C van den Broek Journal: J Cardiothorac Surg Date: 2019-10-22 Impact factor: 1.637