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Ökmen K, Balk Ş, Güvenç GG. The effect of different regional analgesia methods on chronic pain after thoracic surgery. Kardiochir Torakochirurgia Pol 2023; 20:233-239. [PMID: 38283556 PMCID: PMC10809817 DOI: 10.5114/kitp.2023.134175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/07/2023] [Indexed: 01/30/2024]
Abstract
Introduction Chronic postsurgical pain (CPSP) is defined as pain persisting for ≥ 3 months after surgery, severely impairing patients' long-term daily activities and quality of life. Aim To evaluate the effects of various regional analgesia methods, including thoracic epidural (TE), serratus anterior plane (SAP) block, rhomboid intercostal block (RIB) and paravertebral block (PVB), on the incidence of chronic post-thoracic surgery pain. Material and methods A total of 489 patients (240 thoracotomy, 249 VATS) were included in the analysis. The primary outcome measure was the VAS score (postoperative 6th month), while the secondary outcome measures were the LANSS score (postoperative 6th month), the use of analgesic medication and descriptive information. Results In thoracotomy patients, VAS scores were statistically significantly lower in patients who underwent RIB and SAP block compared to those who underwent TE and patient-controlled anesthesia (PCA). LANSS scores did not differ between the RIB, SAP and TE groups, while higher scores were found in the PCA group. After VATS, VAS scores were statistically significantly lower in patients who underwent RIB, SAP and PVB block compared to the PCA group. LANSS scores were statistically significantly lower in the RIB and SAP block groups than in the PVB and PCA groups. Conclusions This study found that patients who received regional anesthesia had lower LANSS scores and VAS values, indicative of neuropathic pain reduction, following thoracotomy and VATS procedures.
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Affiliation(s)
- Korgün Ökmen
- Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Şule Balk
- Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Gamze Gözen Güvenç
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Bursa, Turkey
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Farkas A, Csókási T, Fabó C, Szabó Z, Lantos J, Pécsy B, Lázár G, Rárosi F, Kecskés L, Furák J. Chronic postoperative pain after non-intubated uniportal VATS lobectomy. Front Surg 2023; 10:1282937. [PMID: 38026483 PMCID: PMC10679439 DOI: 10.3389/fsurg.2023.1282937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Patients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy. Methods Demographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery. Results Thirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not. Conclusion Our study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.
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Affiliation(s)
- Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Tímea Csókási
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Csongor Fabó
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Pécsy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - László Kecskés
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
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Leivaditis V, Grapatsas K, Ehle B, Dahm M, Chatzimichalis A, Margaritis E, Baltayiannis N, Charokopos N, Sakellaropoulos G, Verras GI, Schizas D, Mulita A, Panagiotopoulos I, Mulita F, Koletsis E. Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy. Kardiochir Torakochirurgia Pol 2023; 20:193-199. [PMID: 37937165 PMCID: PMC10626407 DOI: 10.5114/kitp.2023.131940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/18/2023] [Indexed: 11/09/2023]
Abstract
Minimally invasive thoracic techniques often need to be converted to open thoracotomy. Thoracotomy is associated with severe postoperative pain in 50% of the patients, and this situation can be maintained for a prolonged period. Many efforts have been made to avoid this complication. We propose an easy and fast thoracotomy closure technique to avoid nerve entrapment at the time of chest closure suitable for cases of conversion to thoracotomy after a minimally invasive attempt. The proposed method effectively avoids interference with the intercostal nerve, which remains intact and restores the anatomy of the intercostal space. Efforts to decrease postoperative pain are vital. Thoracic surgeons are the principal health professionals able to deal with operative factors and postoperative pain management. We believe that the use of this easy and fast technique can facilitate excellent anatomic repositioning of the ribs alongside nerve sparing.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Patras, Greece
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | | | - Emmanuil Margaritis
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Patras, Greece
| | | | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Patras, Greece
| | | | | | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Admir Mulita
- Department of Medical Physics, School Of Medicine, University of Patras, Patras, Greece
| | - Ioannis Panagiotopoulos
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Francesk Mulita
- Department of General Surgery, University of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Patras, Greece
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4
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Muacevic A, Adler JR, Gabriel RA. Ultrasound-Guided Percutaneous Cryoneurolysis for Post-Thoracotomy Pain Syndrome: A Case Report. Cureus 2022; 14:e32888. [PMID: 36699749 PMCID: PMC9867988 DOI: 10.7759/cureus.32888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Post-thoracotomy pain syndrome (PTPS) is a post-operative thoracotomy complication that is difficult to treat. We describe the first-time use of ultrasound-guided percutaneous cryoneurolysis of the intercostal nerves to successfully treat PTPS refractory to conventional medications and interventions. We report a case of a 40-year-old male with two years of severe PTPS sustained after undergoing a thoracotomy. Treatment with intercostal cryoneurolysis resulted in an immediate 75% improvement in pain for six weeks followed by sustained 50% pain relief for eight weeks. This highlights the potential of this intervention as a radiation-free, safe, and efficacious therapy for chronic PTPS.
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Semyonov M, Fedorina E, Shalman A, Dubilet M, Refaely Y, Ruderman L, Frank D, Gruenbaum BF, Koyfman L, Friger M, Zlotnik A, Klein M, Brotfain E. Serratus Anterior Block for Long-Term Post-Thoracoscopy Pain Management. J Pain Res 2021; 14:3849-3854. [PMID: 34949940 PMCID: PMC8689512 DOI: 10.2147/jpr.s295019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/18/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Neuropathic, chronic pain is a common and severe complication following thoracic surgery, known as post-thoracotomy pain syndrome (PTPS). Here we evaluated the efficacy of an ultrasound-guided serratus anterior plane block (SAPB) on pain control compared to traditional pain management with intravenous opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) six months after thoracic surgery. Patients and Methods In this retrospective observational study, we analyzed data from a questionnaire survey. We interviewed all patients who underwent elective video-assisted thoracoscopy surgery (VATS) at Soroka University Medical Center between December 2016 and January 2018. The responses of ninety-one patients were included. Results Participants reported PTPS in both groups, 43% of patients in the SAPB group and 57% of patients in the standard group, which failed to reach significance. However, we demonstrated that the percentage of pain occurrence trended lower in the SAPB group. There was significantly less burning/stitching or shooting, shocking, pressure-like, and aching pain in SAPB patients compared to the standard protocol group. Patients in the SAPB group had significantly less pain located in the upper and lower posterior thorax anatomical regions compared to the standard protocol group. Moreover, we found a significant difference in occurrence of PTPS depending on the type of thoracic surgery. From both study groups, 69% of patients who underwent lobectomy reported pain, compared with 41.9% of those in the segmental (wedge resection) procedure, and 42.1% of patients in other procedures. Conclusion While the present study did not demonstrate a statistically significant reduction of PTPS after SAPB concerning postoperative pain control, there was a trend of a decrease. We also found significance in the type of pain and location of pain after thoracic surgery between the two groups, as well as a significant difference between pain occurrence in types of thoracic surgeries from both groups.
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Affiliation(s)
- Michael Semyonov
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ekaterina Fedorina
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anna Shalman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Dubilet
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yael Refaely
- Department of Cardiothoracic Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Ruderman
- Department of Cardiothoracic Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dmitry Frank
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Leonid Koyfman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Moti Klein
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Evgeni Brotfain
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Israel JE, St Pierre S, Ellis E, Hanukaai JS, Noor N, Varrassi G, Wells M, Kaye AD. Ketamine for the Treatment of Chronic Pain: A Comprehensive Review. Health Psychol Res 2021; 9:25535. [PMID: 34746491 DOI: 10.52965/001c.25535] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Chronic pain significantly worsens the quality of life. Unlike neuropathic, musculoskeletal, postoperative pain, and cancer pain, chronic primary pain cannot be explained by an underlying disease or condition, making its treatment arduous. Objectives This manuscript intends to provide a comprehensive review of the use of ketamine as a treatment option for specific chronic pain conditions. Study Design A review article. Setting A review of the literature. Methods A search was done on PubMed for relevant articles. Results A comprehensive review of the current understanding of chronic pain and the treatment of specific chronic pain conditions with ketamine. Limitations Literature is scarce regarding the use of ketamine for the treatment of chronic pain. Conclusion First-line treatment for many chronic pain conditions includes NSAIDs, antidepressants, anticonvulsants, and opioids. However, these treatment methods are unsuccessful in a subset of patients. Ketamine has been explored in randomized controlled trials (RCTs) as an alternative treatment option, and it has been demonstrated to improve pain symptoms, patient satisfaction, and quality of life. Conditions highlighted in this review include neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS), phantom limb pain (PLP), cancer pain, and post-thoracotomy pain syndrome. This review will discuss conditions, such as neuropathic pain, fibromyalgia, complex regional pain syndrome, and more and ketamine's efficacy and its supplementary benefits in the chronic pain patient population. As the opioid crisis in the United States continues to persist, this review aims to understand better multimodal analgesia, which can improve how chronic pain is managed.
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Affiliation(s)
| | | | - Emily Ellis
- Louisiana State University Health Shreveport
| | | | | | | | | | - Alan D Kaye
- Louisiana State University Health Shreveport
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Petrache IA, Oancea C, Hasan EM, Neagoe OC, Tudorache E, Ionica M, Burlacu ON. New Thoracotomy Closure, a Simple Way to Decrease Chronic Post-Operative Pain in Selected Patients-Blinded Prospective Study. J Pers Med 2021; 11:1007. [PMID: 34683147 DOI: 10.3390/jpm11101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Chronic post-thoracotomy pain syndrome (PTPS) is a very common and uncomfortable complication, occurring frequently after thoracic operations, leading to the necessity of further medication and hospitalizations. One important risk factor in developing chronic pain is the chest closure technique, which can lead to chronic intercostal nerve damage. This study proposes an alternative nerve-sparring closure technique to standard peri-costal sutures, aimed toward minimizing the risk of chronic pain in selected patients. Materials and Methods: We performed a prospective randomized study on 311 patients operated for various thoracic pathology over a period of 12 months, evaluating incision types, chest closure technique, and number of drains with drainage duration. The patients were divided into three groups: peri-costal (PC), proposed extra-costal (EC), and simple (SC) suture, respectively. Pain was measured on day 1, 2, 5, 7, and at 6 months post-operatively using the Visual Analogic Scale. Results: No significant differences in pain level were recorded in the first two post-operative days between the PC and EC groups. However, a significant decrease in pain level was observed on day 5 and at 6 months post-operatively, with a mean level of 3.5 ± 1.8, 1.2 ± 1 for the EC group compared to a mean value of 5.3 ± 1.6, 3.2 ± 1.5, respectively. No significant differences were observed regarding other evaluated variables. Conclusions: The lower recorded pain scores in patients with extra-costal chest closure are a strong argument to use this technique. Its ease of use is similar to the classic peri-costal closure, and the time needed to perform it is not significantly increased. The association of this technique with less invasive procedures and short drainage duration limits chronic post-operative pain. This procedure may represent an option for decreasing healthcare costs associated with the management of PTPS.
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Lei Y, Liu H, Xia F, Gan S, Wang Y, Huo W, Wang Q, Ji F. Effects of Esketamine on Acute and Chronic Pain After Thoracoscopy Pulmonary Surgery Under General Anesthesia: A Multicenter-Prospective, Randomized, Double-Blind, and Controlled Trial. Front Med (Lausanne) 2021; 8:693594. [PMID: 34568362 PMCID: PMC8455819 DOI: 10.3389/fmed.2021.693594] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Post-operative pain management for patients undergoing thoracoscopy surgery is challenging for clinicians which increase both health and economic burden. The non-selective NMDA receptor antagonist esketamine possesses an analgesic effect twice that of ketamine. The application of esketamine might be beneficial in alleviating acute and chronic pain after thoracic surgery. The current study describes the protocol aiming to evaluate the analgesic effect of esketamine after pulmonary surgery via visual analog scale (VAS) score for acute and chronic pain. Methods: A multi-center, prospective, randomized, controlled, double-blind study is designed to explore the analgesic effect of esketamine in randomized patients undergoing video-assisted thoracoscopic surgery (VATS) with general anesthesia. Patients will be randomly assigned to Esketamine Group (Group K) and Control Group (Group C) in a ratio of 1:1. Group K patients will receive esketamine with a bolus of 0.1 mg/kg after anesthesia induction, 0.1 mg/kg/h throughout the operation and 0.015 mg/kg/h in PCIA after surgery while Group C patients will receive the same volume of normal saline. The primary outcome is to measure the pain intensity through the VAS score at 3 months after the operation. The secondary outcome includes VAS score at 1, 4, 8, 24, and 48 h and on the 7th day and 1 month after the operation, complications, ketamine-related neurological side effects, recovery time of bowel function, and total amount of supplemental analgesics. Discussion: The results of the current study might illustrate the analgesic effect of esketamine for patients undergoing thoracoscopy pulmonary surgery and provide evidence and insight for perioperative pain management. Study Registration: The trial was registered with Chinese Clinical Trial Registry (CHICTR) on Nov 18th, 2020 (ChiCTR2000040012).
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Affiliation(s)
- Yishan Lei
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huayue Liu
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fan Xia
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shulin Gan
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yulan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenwen Huo
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qinyun Wang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fuhai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Kurt Saruhan H, Toprak M. Pain-diminishing and quality of life-related outcomes of Kinesio taping in patients on non-steroidal anti-inflammatory drug therapy for post-thoracotomy pain syndrome. Turk J Phys Med Rehabil 2020; 66:147-53. [PMID: 32760891 DOI: 10.5606/tftrd.2020.4068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/19/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate pain-diminishing and quality of life-related outcomes of Kinesio taping in patients on non-steroidal anti-inflammatory drug (NSAID) therapy for post-thoracotomy pain syndrome (PTPS). Patients and methods Between February 2016 and May 2017, a total 60 patients (39 males, 21 females; median age 43.5 years; range, 18 to 76 years) with PTPS were included in this single-center, prospective, randomized study. The patients were randomized into two groups based on five-day pain management protocol including NSAIDs per se (NSAID group; n=30) and NSAIDs plus Kinesio taping (NSAID-KT group; n=30) groups. Pain intensity (via visual pain scale [VAS]), neuropathic pain (Leeds Assessment of Neuropathic Symptoms and Signs [LANSS] Pain Scale), major chronic pain symptoms (via Short-Form McGill Pain Questionnaire [SF-MPQ-2]), and quality of life (via Nottingham Health Profile [NHP]) were assessed before and after five-day treatment period. Results In both NSAID and NSAID-KT groups, treatment was associated with a significant decrease in the VAS-pain (p<0.001), LANSS Pain Scale scores (from median 8.0 to 3.0 and from median 18.5 to 15.0, respectively, p<0.001 for each), SF-MPQ scores (p<0.001), and physical mobility and pain domains of NHS (p<0.001 for each). Conclusion In conclusion, our study findings indicate no additional benefit of KT application on further amelioration of long-term PTPS in patients under NSAID analgesia. Both NSAID and NSAID-KT treatments produced a significant improvement in the VAS, LANSS, SF-MPQ scores, and in the quality of life after five-day treatment.
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10
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Piraccini E, Biondi G, De Lorenzo E, Corso RM, Maitan S. Ultrasound-guided erector spinae block for post-thoracotomy pain syndrome in video-assisted thoracic surgery. Tumori 2020; 106:NP46-NP48. [PMID: 32194005 DOI: 10.1177/0300891620912024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes our experience with 5 patients with post-thoracotomy pain syndrome after video-assisted thoracoscopic lobectomies, treated with weekly erector spinae plane block. We injected corticosteroid and local anesthetic. At the end of the treatment period, pain scores decreased significantly. Our experience suggests that erector spinae plane block may have a role in the treatment of post-thoracoscopy pain syndrome.
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Affiliation(s)
- Emanuele Piraccini
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Giulia Biondi
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Eleonora De Lorenzo
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Ruggero M Corso
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Stefano Maitan
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
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11
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Abstract
Scar pain from thoracotomy, hepatectomy, or similar operations is distressing and difficult to treat. Scrambler Therapy is a novel form of superficial neuromodulation that has been effective in treating different types of neuropathic pain. We report here two cases of dramatic relief from disabling scar pain with one or two sessions of Scrambler Therapy.
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Affiliation(s)
- Mark Yarchoan
- Oncology, Gastrointestinal Cancer, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, USA
| | - Jarushka Naidoo
- Oncology, Upper Aerodigestive Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, USA
| | - Thomas J Smith
- Oncology, Hospice and Palliative Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, USA
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12
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Rashid S, Fields AR, Baumrucker SJ. Subcutaneous Botulinum Toxin Injection for Post-Thoracotomy Pain Syndrome in Palliative Care: A Case Report. Am J Hosp Palliat Care 2017. [PMID: 28641445 DOI: 10.1177/1049909117716460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Post-thoracotomy pain syndrome (PTPS) is a traumatic neuropathy that can affect as many as 50% of patients undergoing thoracotomy. Patients are often refractory to conservative management and may require multiple analgesics for adequate pain control. Botulinum toxin, derived from Clostridium botulinum, has many uses in treating conditions involving spasticity, dystonia, chronic migraine, and a variety of pain disorders including neuropathies. Botulinum toxin type A injections may provide an alternative or adjunct to improve symptom management in patients with PTPS.
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Affiliation(s)
- Saima Rashid
- 1 East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, USA
| | - Amanda R Fields
- 1 East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, USA
| | - Steven J Baumrucker
- 2 Hospice and Palliative Medicine, Wellmont Health System, Kingsport, TN, USA
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Hetmann F, Kongsgaard UE, Sandvik L, Schou-Bredal I. Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6- and 12-month follow-ups. J Pain Res 2017; 10:663-668. [PMID: 28356766 PMCID: PMC5367586 DOI: 10.2147/jpr.s126639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Persistent pain affects a large proportion of patients after thoracotomy and is associated with sensory disturbances. The objective of this prospective study was to investigate the time course of pain and sensory disturbances over a 12-month period. Methods Patients scheduled for thoracotomy were recruited. Data were collected on the day before surgery, including baseline characteristics and the presence of any preoperative pain. At 6- and 12-month follow-ups, data on pain were collected using the Brief Pain Inventory-Short Form, and perceived sensory disturbances around the thoracotomy scar were recorded from a self-exploration test. Results At 12 months after surgery, 97 patients had complete data including baseline and 6-and 12-month measurements. Almost half of the patients reported post-thoracotomy pain at the follow-ups. However, 20% of the patients not reporting post-thoracotomy pain at 6 months did report it at 12 months. Between 40% and 60% of patients experienced some kind of sensory disturbance at 6 months. A small decline in some kind of sensory disturbance was reported by 20%–50% of patients at 12 months. Conclusion A proportion of patients experienced either resolved or delayed onset of pain. Sensory changes were strongly associated with post-thoracotomy pain syndrome, but were also present in a large proportion of patients without it.
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Affiliation(s)
- Fredrik Hetmann
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences
| | - Ulf E Kongsgaard
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital; Medical Faculty, University of Oslo
| | - Leiv Sandvik
- Department of Biostatistics and Epidemiology, Division of Oslo Hospital Services
| | - Inger Schou-Bredal
- Medical Faculty, University of Oslo; Department of Breast and Endocrine Surgery, Division of Cancer and Surgery, Oslo University Hospital, Oslo, Norway
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Dutta V, Kumar B, Jayant A, Mishra AK. Effect of Continuous Paravertebral Dexmedetomidine Administration on Intraoperative Anesthetic Drug Requirement and Post-Thoracotomy Pain Syndrome After Thoracotomy: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2016; 31:159-165. [PMID: 27554227 DOI: 10.1053/j.jvca.2016.05.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the effect of paravertebral administration of dexmedetomidine as an adjuvant to local anesthetic on the intraoperative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome. DESIGN Prospective, randomized, controlled, double-blind trial. SETTING Single university hospital. PARTICIPANTS The study comprised 30 patients who underwent elective thoracotomy and were assigned randomly to either the Ropin or Dexem group (n = 15 each). INTERVENTIONS All patients received the study medications through paravertebral catheter. Patients in the Ropin group received a bolus of 15 mL of 0.75% ropivacaine over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine at 0.1 mL/kg/hour. Patients in the Dexem group received 15 mL of 0.75% ropivacaine plus dexmedetomidine, 1 µg/kg bolus over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine plus 0.2 µg/kg/hour of dexmedetomidine at 0.1 mL/kg/hour. MEASUREMENTS AND MAIN RESULTS The primary outcome of the study was intraoperative anesthetic drug requirement. The secondary outcome was the incidence of post-thoracotomy pain syndrome 2 months after surgery. The amount of propofol required for induction of anesthesia was significantly less in the Dexem group (Dexem 49.33±20.51 v 74.33±18.40 in the Ropin group, p = 0.002). End-tidal isoflurane needed to maintain target entropy was significantly less in the Dexem group at all time points. Intraoperative fentanyl requirement was lower in the Dexem group (Dexem 115.33±33.77 v 178.67±32.48 in the Ropin group, p = 0.002). Postoperative pain scores and morphine consumption were significantly less in the Dexem group (p<0.001). The incidence of post-thoracotomy pain syndrome was comparable between the 2 groups (69.23% v 50%, p = 0.496). CONCLUSIONS Paravertebral dexmedetomidine administration resulted in decreased intraoperative anesthetic drug requirement, less pain, and lower requirements of supplemental opioid in the postoperative period. However, it had no effect on the incidence of post-thoracotomy pain syndrome.
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Affiliation(s)
- Vikas Dutta
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhupesh Kumar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Aveek Jayant
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand K Mishra
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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