A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia

Anesthesia and Analgesia
G P JoshiH Kehlet

Abstract

Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation of the evidence is needed to assess the comparative benefits of alternative techniques, guide clinical practice and identify areas requiring further research. In this systematic review of randomized trials we evaluated thoracic epidural, paravertebral, intrathecal, intercostal, and interpleural analgesic techniques, compared to each other and to systemic opioid analgesia, in adult thoracotomy. Postoperative pain, analgesic use, and complications were analyzed. Continuous paravertebral block was as effective as thoracic epidural analgesia with local anesthetic (LA) but was associated with a reduced incidence of hypotension. Paravertebral block reduced the incidence of pulmonary complications compared with systemic analgesia, whereas thoracic epidural analgesia did not. Thoracic epidural analgesia was superior to intrathecal and intercostal techniques, although these were superior to systemic analgesia; interpleural analgesia was inadequate. Either thoracic epid...Continue Reading

References

Nov 11, 1975·Anesthesia and Analgesia·J A KaplanE G gallagher
Jan 1, 1992·Scandinavian Journal of Thoracic and Cardiovascular Surgery·J Eng, S Sabanathan
Sep 1, 1991·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·V W ChanT J Kirby
Jan 1, 1990·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·R G BerrisfordP J Bickford-Smith
Feb 1, 1989·Acta Anaesthesiologica Scandinavica·B ScheininP H Rosenberg
Aug 1, 1986·Acta Anaesthesiologica Scandinavica·R AsantilaB Scheinin
Dec 1, 1983·The New England Journal of Medicine·T C ChalmersH Smith
Nov 1, 1995·British Journal of Anaesthesia·K PerttunenE Kalso
Jan 1, 1994·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·P Y BrichonR Sarrazin
Aug 1, 1994·Journal of Cardiothoracic and Vascular Anesthesia·F W BurgessD G Cavanaugh
May 1, 1994·Acta Anaesthesiologica Scandinavica·V BrockmeierP A Steen
Sep 1, 1994·Anesthesiology·B P KavanaghA N Sandler
Oct 1, 1993·Journal of Cardiothoracic and Vascular Anesthesia·R Miguel, D Hubbell
May 1, 1993·British Journal of Anaesthesia·C M DrydenD J Duthie
Jan 1, 1993·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·B Bachmann-MennengaG Hempelmann
Feb 1, 1993·The Annals of Thoracic Surgery·M DeneuvilleP Hervé
Oct 1, 1995·Journal of Cardiothoracic and Vascular Anesthesia·B AykaçO Yillar
Feb 1, 1996·Controlled Clinical Trials·A R JadadH J McQuay
Mar 1, 1996·The Clinical Journal of Pain·J KatzA N Sandler
Oct 1, 1996·Anesthesia and Analgesia·O A de Leon-Casasola, M J Lema
May 16, 1998·Journal of Cardiothoracic and Vascular Anesthesia·J RichardsonA J Mearns
Jun 8, 2001·European Journal of Pain : EJP·Y GotodaT Koyama
Sep 28, 2001·British Journal of Anaesthesia·N MasonF Bonnet
Jan 5, 2002·Anesthesia and Analgesia·Mert SentürkKamil Pembeci

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Citations

Aug 12, 2009·Der Anaesthesist·S Reichl, E Pogatzki-Zahn
Mar 20, 2010·Journal of Anesthesia·Soichiro Inoue
May 15, 2013·Journal of Anesthesia·Toshiyuki MizotaKazuhiko Fukuda
Jun 26, 2013·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Christopher VoscopoulosKamen Vlassakov
Sep 3, 2013·Annales Françaises D'anesthèsie Et De Rèanimation·G GayraudC Dualé
Jan 15, 2011·British Journal of Anaesthesia·J RichardsonZ Naja
Feb 4, 2011·British Journal of Anaesthesia·E S PowellUNKNOWN UKPOS Investigators
Oct 15, 2011·British Journal of Anaesthesia·P C Thornton, D J Buggy
May 15, 2012·British Journal of Anaesthesia·P J FagenholzW S Walker
Aug 16, 2013·British Journal of Anaesthesia·M CarassitiR Cataldo
Jan 6, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Kim WildgaardHenrik Kehlet
Apr 24, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Kasper GrosenHans K Pilegaard
Jul 14, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Catherine JosephFrançois Kerbaul
Feb 22, 2012·Interactive Cardiovascular and Thoracic Surgery·Hany Elsayed
Oct 27, 2010·Regional Anesthesia and Pain Medicine·Barrie Fischer
Oct 18, 2011·Regional Anesthesia and Pain Medicine·Francesco CarliJoseph M Neal
Jun 24, 2011·Regional Anesthesia and Pain Medicine·Jeremy Kaplowitz
Apr 26, 2012·Regional Anesthesia and Pain Medicine·Narinder Rawal
Aug 3, 2012·Regional Anesthesia and Pain Medicine·Ottokar Stundner, Stavros G Memtsoudis
Jan 29, 2013·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·G P JoshiUNKNOWN PROSPECT collaboration
Aug 1, 2009·Journal of Cardiothoracic Surgery·Ellie S PowellUNKNOWN UKPOS Co-ordinators
Dec 25, 2010·Annals of Surgical Oncology·Urs ZinggDavid I Watson
Jan 12, 2012·Annals of Cardiac Anaesthesia·Alexandre YazigiKhalil Jabbour
Aug 1, 2013·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Delphine MitilianUNKNOWN Foch Lung Transplant Group
Oct 9, 2012·Annals of Cardiac Anaesthesia·Gamal Z El-MorsyMohamed Adel F Elgamal
Jun 7, 2014·Der Schmerz·J S Englbrecht, E M Pogatzki-Zahn
Nov 30, 2013·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Kristin Julia SteinthorsdottirKim Wildgaard
Jun 3, 2014·World Journal of Surgical Oncology·Gonul SagirogluSerhat Huseyin
May 13, 2014·Best Practice & Research. Clinical Anaesthesiology·Christopher K MerrittRichard D Urman
May 27, 2014·Journal of Clinical Anesthesia·Federico PiccioniMartin Langer
Jul 6, 2014·Best Practice & Research. Clinical Anaesthesiology·Girish P JoshiHenrik Kehlet
Nov 9, 2014·Der Orthopäde·D MeisenzahlP Kessler
Dec 3, 2014·The Surgical Clinics of North America·Elie RamlyGeorge C Velmahos
Mar 12, 2010·Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række·Harald Breivik, Hilde M Norum

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