Redondo GZ, Díaz MM, Pascual VH, García GD

Language: Spanish
References: 38
Page: 70-79
PDF size: 247.62 Kb.

ABSTRACT

Background: Thoracotomy is one of the most painful surgical incisions. The surgical exposure of the thoracic cavity causes damage to multiple structures in the nociceptive chest wall and cardiopulmonary viscera. There is a high incidence of chronic and acute postoperative pain that can delay the recovery and cause long-term disability. The prevention and treatment of post-thoracotomy pain is a challenge that may require a variety of surgeries and is of vital importance to minimize pulmonary complications.
Objective: To show strategies for the prevention and treatment of this type of pain.
Methods: A detailed review of the available literature in relation to evidence-based strategies for the prevention and treatment of post-thoracotomy pain was made.
Results: The suboptimal treatment of post-thoracotomy pain has important implications, especially in patients with limited pulmonary reserve, being pulmonary dysfunction the most frequent and important one. The general principles for the treatment of post-thoracotomy pain and current techniques to deal with its control are shown.
Conclusions: Thoracic epidural analgesia is currently the standard analgesia after a thoracic surgery and in the absence of contraindications, all patients scheduled for this type of surgery should have been placed a preoperative thoracic epidural catheter.

REFERENCES

1. Ochroch EA, Gottschalk A, Augostides J, Carson KA, Kent L, Malayaman N, Kaiser LR, Aukburg SJ: Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology. 2002; 97:1234-44.

2. Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology. 2006;104:594-600.

3. Waurick R, Van Aken H. Update in thoracic epidural anaesthesia. Best Practice & Research Clinical Anaesthesiology. 2005;19(2):201-13.

4. Block BM, Liu SS, Rowlingson AJ. Efficacy of postoperative epidural analgesia. JAMA. 2003; 90:2455-63.

5. Vaporciyan AA, Correa AM, Rice DC. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004; 27:779-86.

6. Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin. 2005;15(1):105-21.

7. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22:588-93.

8. Kissin I. Preemptive analgesia: Why its effect is not always obvious. Anesthesiology. 1996;84:1015-19.

9. Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: The role of timing of analgesia. Anesthesiology. 2002;96:725-41.

10. Kissin I. Study design to demonstrate clinical value of preemptive analgesia: is the commonly used approach valid? Reg Anesth Pain Med. 2002;27(3):242-44.

11. Kissin I. Preemptive analgesia. Anesthesiology. 2000;93(4):1138-43.

12. Joshi GP, Bonnet F, Shah R. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107:1026-40.

13. Popping DM, Elia N, Marret E. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a metaanalysis. Arch Surg. 2008;143:990-99.

14. Ali M, Winter DC, Hanly AM. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth. 2010;104:292-97.

15. Amr YM, Yousef AA, Alzeftawy AE. Effect of preincisional epidural fentanyl and bupivacaine on post-thoracotomy pain and pulmonary function. Ann Thorac Surg. 2010;89:381-85.

16. Daly DJ, Myles PS. Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol. 2009;22:38-43.

17. Scarci M, Joshi A, Attia R. In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management? Interact Cardiovasc Thorac Surg. 2010;10:92-96.

18. Gulbahar G, Kocer B, Muratli SN. A comparison of epidural and paravertebral catheterisation techniques in postthoracotomy pain management. Eur J Cardiothorac Surg. 2010;37:467-72.

19. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs. epidural blockade for thoracotomy: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96:418-26.

20. Debreceni G, Molnar Z, Szelig L, Molnar TF. Continuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double blind clinical trial. Acta Anaesthesiol Scand. 2003;47:1091-95.

21. Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg. 2005;80(4):1550-59.

22. Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345-60.

23. Askar FZ, Kocabas S, Yucel S. The efficacy of intrathecal morphine in postthoracotomy pain management. J Int Med Res. 2007;35(3):314-22.

24. Danelli G, Berti M, Casati A. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2% wt/vol ropivacaine. Eur J Anaesthesiol. 2007;24(7):596-601.

25. Mac TB, Girard F, Chouinard P. Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study. J Cardiothorac Vasc Anesth. 2005;19(4):475-78.

26. Ali M, Winter DC, Hanly AM. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth. 2010;104:292-97.

27. Hudcova J, McNicol E, Quah C. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2006;( 4):CD003348.

28. Della RG, Coccia C, Pompei L. Post-thoracotomy analgesia: epidural vs. intravenous morphine continuous infusion. Minerva Anestesiol. 2002;68(9):681-93.

29. Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetaminophen, nonsteroidal anti-inflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005;103:1296-304.

30. Straube S, Derry S, McQuay HJ. Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: a systematic review of randomized studies. Acta Anaesthesiol Scand. 2005;49:601-13.

31. Brophy JM. Celecoxib and cardiovascular risks. Expert Opin Drug Saf. 2005;4:1005-15.

32. Senard M, Deflandre EP, Ledoux D. Effect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy. Br J Anaesth. 2010;105:196-200.

33. Sihoe AD, Lee TW, Wan IY. The use of gabapentin for post-operative and posttraumatic pain in thoracic surgery patients. Eur J Cardiothorac Surg. 2006;29:795-99.

34. Nesher N, Ekstein MP, Paz Y. Morphine with adjuvant ketamine vs higher dose of morphine alone for immediate post-thoracotomy analgesia. Chest. 2009;136:245-52.

35. Nesher N, Serovian I, Marouani N. Ketamine spares morphine consumption after transthoracic lung and heart surgery without adverse hemodynamic effects. Pharmacol Res. 2008;58:38-44.

36. Sveticic G, Gentilini A, Eichenberger U, Zanderigo E, Sartori V, Luginbuhl M, et al. Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: A novel optimization procedure. Anesthesiology. 2004;101:1381-93.

37. Wu N, Yan S, Wang X. A prospective, single-blind randomised study on the effect of intercostal nerve protection on early post-thoracotomy pain relief. Eur J Cardiothorac Surg. 2010;37:840-45.

38. Allama AM. Intercostal muscle flap for decreasing pain after thoracotomy: a prospective randomized trial. Ann Thorac Surg. 2010;89:195-99.