Molly Cason1, Ami Naik1, Joshua C Grimm2, David Hanna3, Lea Faraone1, Jason C Brookman1, Ashish Shah2, Marie N Hanna4. 1. Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD. 2. Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institution. 3. University of Maryland, School of Medicine, College Park, MD. 4. Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD. Electronic address: mhanna9@jhmi.edu.
Abstract
OBJECTIVE: Successful pain management after lung transplantation is critical to ensure adequate respiratory effort and graft expansion. The authors investigated whether thoracic epidural analgesia (TEA) provided adequate pain control after lung transplantation without added morbidity. DESIGN: Retrospective review. SETTING: University teaching hospital. PARTICIPANTS: One hundred twenty-three patients who presented to this institution for lung transplantation from January 2008 to June 2013. INTERVENTIONS: Patient demographics, postoperative pain scores, and epidural-related complications were abstracted from the institutional electronic database. The authors used the previously validated Quality of Recovery (QoR) score and Visual Analog Scale (VAS) as measures of recovery. MEASUREMENTS AND MAIN RESULTS: Of the 123 patients who underwent lung transplantation in this time frame, 119 patients had thoracic epidurals placed for postoperative analgesia. The mean age was 49.4 years (range, 18-73), and 60 (50.4%) were male. The most common indications for transplant were pulmonary fibrosis (33.6%), cystic fibrosis (26.1%), and chronic obstructive pulmonary disease (20.2%). The median length of stay in the intensive care unit and duration of mechanical ventilation were 21 and 1.2 days, respectively. Eight (6.7%) patients experienced postoperative pulmonary compromise (eg, pneumonia, prolonged intubation). No serious complications were associated with TEA placement. On days 1, 3, and 7 after TEA placement, the mean QoR was 7.6, 9.4, and 9.7, and the mean VAS was 2.5, 2.1, and 2.0, respectively. CONCLUSIONS: In this case series, the authors observed excellent analgesia and no serious complications associated with TEA. Therefore, an epidural-centric approach to pain control after lung transplantation should be considered in appropriate patients.
OBJECTIVE: Successful pain management after lung transplantation is critical to ensure adequate respiratory effort and graft expansion. The authors investigated whether thoracic epidural analgesia (TEA) provided adequate pain control after lung transplantation without added morbidity. DESIGN: Retrospective review. SETTING: University teaching hospital. PARTICIPANTS: One hundred twenty-three patients who presented to this institution for lung transplantation from January 2008 to June 2013. INTERVENTIONS:Patient demographics, postoperative pain scores, and epidural-related complications were abstracted from the institutional electronic database. The authors used the previously validated Quality of Recovery (QoR) score and Visual Analog Scale (VAS) as measures of recovery. MEASUREMENTS AND MAIN RESULTS: Of the 123 patients who underwent lung transplantation in this time frame, 119 patients had thoracic epidurals placed for postoperative analgesia. The mean age was 49.4 years (range, 18-73), and 60 (50.4%) were male. The most common indications for transplant were pulmonary fibrosis (33.6%), cystic fibrosis (26.1%), and chronic obstructive pulmonary disease (20.2%). The median length of stay in the intensive care unit and duration of mechanical ventilation were 21 and 1.2 days, respectively. Eight (6.7%) patients experienced postoperative pulmonary compromise (eg, pneumonia, prolonged intubation). No serious complications were associated with TEA placement. On days 1, 3, and 7 after TEA placement, the mean QoR was 7.6, 9.4, and 9.7, and the mean VAS was 2.5, 2.1, and 2.0, respectively. CONCLUSIONS: In this case series, the authors observed excellent analgesia and no serious complications associated with TEA. Therefore, an epidural-centric approach to pain control after lung transplantation should be considered in appropriate patients.
Authors: Marc Giménez-Milà; Sebastián Videla; Natalia Pallarés; Antoni Sabaté; Jasvir Parmar; Pedro Catarino; Will Tosh; Muhammad Umar Rafiq; Jacinta Nalpon; Kamen Valchanov Journal: Medicine (Baltimore) Date: 2020-11-13 Impact factor: 1.817