Comparative characteristics of regional anesthesia methods in thoracic surgery: a randomized prospective open-label controlled trial
- Authors: Zhikharev V.A.1,2, Koriachkin V.A.3, Bushuev A.S.1, Porkhanov V.A.1,2, Glushchenko V.A.4
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Affiliations:
- Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1, Krasnodar
- Kuban State Medical University
- Saint-Petersburg state pediatric medical university
- Petrov National Medical Research Center of Oncology
- Section: Original study articles
- URL: https://rjraap.com/1993-6508/article/view/111851
- DOI: https://doi.org/10.17816/RA111851
Cite item
Abstract
OBJECTIVE: Comparative analysis of the effectiveness of regional anesthesia methods in thoracic surgery.
MATERIALS AND METHODS: 150 patients were examined, 75 of them underwent thoracotomy and 75 patients underwent surgery with VATS access. Depending on the type of regional anesthesia, patients were divided into one of five groups: group 1 - epidural blockade (n=30); group 2 - paravertebral blockade (n=30); 3rd group - ESP block (n=30), 4th group - SAP block (n=30); group 5 - control, only systemic anesthesia was used (n=30). The intensity of postoperative pain syndrome, the need for promedol and tramadol, the incidence of atelectasis, and hypotension were assessed. The length of stay of patients in the intensive care unit was recorded.
RESULTS: The lowest values of the median pain value during thoracotomy were recorded in patients with epidural blockade. In patients with ESP and SAP blocks, the pain syndrome was more pronounced and corresponded to the median values of the control group. EB and PVB with VATS access had the maximum analgesic effect, and the median values of the pain syndrome during ESP and SAP blocks made it possible to reduce the intensity of the pain syndrome relative to the control group. The general postoperative need for promedol was absent in patients of the epidural and paravertebral blockade groups. In the ESP, SAP-blocks and control groups, narcotic opioids were used in all patients with thoracotomy. With VATS access, in the ESP and SAP-blocks groups and in the control group, all patients in analgesic therapy used a narcotic analgesic. In patients in the control group, FBS was performed more often in absolute terms, however, there were no significant differences (p-value = 0.227, χ2 test). Arterial hypotonia in the epidural blockade group was significantly more common than in patients with other types of anesthesia (p-value=0.0164, chi-square test). The largest number of days the patient stayed in the ICU was recorded in the control group Me [Thoracotomy] - 3 days, Me [VATS] - 2 days. In the control group, only epidural block Me [Thoracotomy] - 2 days, Me [VATS] - 1 day, p=0.022, χ2 criterion and paravertebral block Me [Thoracotomy] - 2 days, Me [VATS] - 1 day, p=0.008, χ2 criterion, allowed to reduce the length of stay of patients in the ICU.
CONCLUSION: With thoracotomy, the choice remains with the epidural or paravertebral method of anesthesia. Epidural blockade more often than others causes the development of arterial hypotension. In the case of VATS access, ESP and SAP blocks can become an alternative to neuraxial methods. During the ESP block, catheterization can reduce the intensity of the pain syndrome compared to patients without it. The use of EB and PVB can reduce the length of stay of patients in the ICU.
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About the authors
Vasiliy A. Zhikharev
Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1, Krasnodar; Kuban State Medical University
Email: Vasilii290873@mail.ru
ORCID iD: 0000-0001-5147-5637
SPIN-code: 7406-7687
MD, Dr. Sci. (Med.), senior resident
167, 1 May Str., Krasnodar, Russia, 350086; 4, Str. n.a. Mitrofan Sedin, Krasnodar, Russia, 350063Victor A. Koriachkin
Saint-Petersburg state pediatric medical university
Author for correspondence.
Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578
MD, Dr. Sci. (Med.), Professor
Russian Federation, 2, Litovskaya Str., St. Petersburg, Russia, 194100Alexandr S. Bushuev
Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1, Krasnodar
Email: ksmukubris@mail.ru
ORCID iD: 0000-0002-1427-4032
SPIN-code: 3640-7080
MD, Cand. Sci. (Med.), medical resident
167, 1 May Str., Krasnodar, Russia, 350086Vladimir A. Porkhanov
Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1, Krasnodar; Kuban State Medical University
Email: vladimirporhanov@mail.ru
ORCID iD: 0000-0003-0572-1395
SPIN-code: 2446-5933
MD, Dr. Sci. (Med.), Professor, Academician of RAS, chief physician, Honored doctor of Russia
167, 1 May Str., Krasnodar, Russia, 350086; 4, Str. n.a. Mitrofan Sedin, Krasnodar, Russia, 350063Vladimir A. Glushchenko
Petrov National Medical Research Center of Oncology
Email: spbgmaanestez@mail.ru
ORCID iD: 0000-0003-2638-5853
SPIN-code: 1274-9977
MD, Dr. Sci. (Med.), Professor, Head of Scientific Department
68, Leningradskaya Str., St. Petersburg, Russia, 197758References
- Marshall K, McLaughlin K. Pain Management in Thoracic Surgery. Thorac Surg Clin. 2020;30(3):339–346. doi: 10.1016/j.thorsurg.2020.03.001
- Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55(1):91–115. doi: 10.1093/ejcts/ezy301
- Gedviliene I, Karbonskiene A, Marchertiene I. A role of thoracic epidural anesthesia in pulmonary resection surgery. Medicina (Kaunas). 2006;42(7):536–541. (In Lithuanian).
- Romero A, Garcia JE, Joshi GP. The state of the art in preventing postthoracotomy pain. Semin Thorac Cardiovasc Surg. 2013;25(2):116–124. doi: 10.1053/j.semtcvs.2013.04.002
- Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2(2):CD009121. doi: 10.1002/14651858.CD009121.pub2
- Liu X, Song T, Xu HY, et al. The serratus anterior plane block for analgesia after thoracic surgery: A meta-analysis of randomized controlled trails. Medicine (Baltimore). 2020;99(21):e20286. doi: 10.1097/MD.0000000000020286
- Bonvicini D, Boscolo-Berto R, De Cassai A, et al. Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study. J Anesth. 2021;35(1):102–111. doi: 10.1007/s00540-020-02881-w
- Xiong C, Han C, Zhao D, et al. Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis. PLoS One. 2021;16(8):e0256611. doi: 10.1371/journal.pone.0256611
- Forero M, Rajarathinam M, Adhikary S, Chin KJ. Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: A Case Report. A A Case Rep. 2017;8(10):254–256. doi: 10.1213/XAA.0000000000000478
- Wylde V, Dennis J, Beswick AD, et al. Systematic review of management of chronic pain after surgery. Br J Surg. 2017;104(10):1293–1306. doi: 10.1002/bjs.10601
- Mayes J, Davison E, Panahi P, et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia. 2016;71(9):1064–1069. doi: 10.1111/anae.13549
- Kukreja P, Herberg TJ, Johnson BM, et al. Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery. Cureus. 2021;13(10):e18533. doi: 10.7759/cureus.18533
- Elsabeeny WY, Ibrahim MA, Shehab NN, et al. Serratus Anterior Plane Block and Erector Spinae Plane Block Versus Thoracic Epidural Analgesia for Perioperative Thoracotomy Pain Control: A Randomized Controlled Study. J Cardiothorac Vasc Anesth. 2021;35(10):2928–2936. doi: 10.1053/j.jvca.2020.12.047
- Chen N, Qiao Q, Chen R, et al. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Clin Anesth. 2020;59:106–111. doi: 10.1016/j.jclinane.2019.07.002
- De Cassai A, Boscolo A, Zarantonello F, et al. Serratus anterior plane block for video-assisted thoracoscopic surgery: A meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2021;38(2):106–114. doi: 10.1097/EJA.0000000000001290
- Harky A, Clarke CG, Kar A, Bashir M. Epidural analgesia versus paravertebral block in video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg. 2019;28(3):404–406. doi: 10.1093/icvts/ivy265
- Finnerty DT, McMahon A, McNamara JR, et al. Comparing erector spinae plane block with serratus anterior plane block for minimally invasive thoracic surgery: a randomised clinical trial. Br J Anaesth. 2020;125(5):802–810. doi: 10.1016/j.bja.2020.06.020
- Ekinci M, Ciftci B, Gölboyu BE, et al. A Randomized Trial to Compare Serratus Anterior Plane Block and Erector Spinae Plane Block for Pain Management Following Thoracoscopic Surgery. Pain Med. 2020;21(6):1248–1254. doi: 10.1093/pm/pnaa101
- 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(1):92–96. doi: 10.1510/icvts.2009.221127
- Rispoli M, Tamburri R, Nespoli MR, et al. Erector spine plane block as postoperative rescue analgesia in thoracic surgery. Tumori. 2020;106(5):388–391. doi: 10.1177/0300891620915783
- Chen JQ, Yang XL, Gu H, et al. The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery. Pain Ther. 2021;10(2):1051–1066. doi: 10.1007/s40122-021-00322-4
- Okajima H, Tanaka O, Ushio M, et al. Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery. J Anesth. 2015;29(3):373–378. doi: 10.1007/s00540-014-1947-y
- Komatsu T, Kino A, Inoue M, et al. Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery. Int J Surg. 2014;12(9):936–939. doi: 10.1016/j.ijsu.2014.07.272
- Jack JM, McLellan E, Versyck B, et al. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review. Anaesthesia. 2020;75(10):1372–1385. doi: 10.1111/anae.15000
- Krishnan S, Cascella M. Erector Spinae Plane Block. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545305/. Accessed: 27.12.2022.
- Dambayev GT, Shefer NA, Sokolovich EG. The Role of Intrapleural Lymphotropic Blockades in the Incidence of Respiratory Complications after Surgical Treatment of Lung Cancer. Acta Biomedica Scientifica. 2019;4(2):65–69. (In Russ). doi: 10.29413/ABS.2019-4.2.10
- Kavochkin AA, Vyzhigina MA, Kabakov DG, et al. Anesthesiological management of thoracoscopic operations on lungs and mediastinum. Messenger of Anesthesiology and Resuscitation. 2020;17(4):113–122. (In Russ). doi: 10.21292/2078-5658-2020-17-4-113-122
- Zhikharev VA, Bushuev AS, Sholin IY, Koriachkin VA. Effectiveness of intravenous influence of lidocaine at analgesia after video-assisted toraccoscopic lobectomy. Regional Anesthesia and Acute Pain Management. 2018;12(3):160–166. (In Russ). doi: 10.18821/1993-6508-2018-12-3-160-166
- Porkhanov VA, Danilov VV, Polyakov IS. Minimally invasive thoracoscopic and robot-assisted lobectomy. Pirogov Journal of Surgery. 2019;8:46–52. (In Russ). doi: 10.17116/hirurgia201908146
