Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to Thoracic Epidural Analgesia

被引:133
作者
Rice, David C. [1 ]
Cata, Juan P.
Mena, Gabriel E.
Rodriguez-Restrepo, Andrea
Correa, Arlene M.
Mehran, Reza J.
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Thorac & Cardiovasc Surg, Houston, TX 77030 USA
关键词
RANDOMIZED CONTROLLED-TRIAL; DOUBLE-BLIND; POSTSURGICAL ANALGESIA; PAIN MANAGEMENT; INJECTION; SURGERY; HEMORRHOIDECTOMY; THORACOTOMY; EFFICACY; RELIEF;
D O I
10.1016/j.athoracsur.2015.02.074
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Pain relief using regional neuroaxial blockade is standard care for patients undergoing major thoracic surgery. Thoracic epidural analgesia (TEA) provides effective postoperative analgesia but has unwanted side effects, including hypotension, urinary retention, nausea, and vomiting, and is highly operator dependent. Single-shot intercostal nerve and paravertebral blockade have not been widely used because of the short duration of action of most local anesthetics; however, the recent availability of liposomal bupivacaine (LipoB) offers the potential to provide prolonged blockade of intercostal nerves (72 to 96 hours). We hypothesized that a five-level unilateral posterior intercostal nerve block using LipoB would provide effective analgesia for patients undergoing thoracic surgery. Methods. We identified patients who underwent lung resection using intraoperative LipoB posterior intercostal nerve blockade and retrospectively compared them with a group of patients who had TEA and who were matched for age, sex, type of surgery, and surgical approach. We analyzed perioperative morbidity, pain scores and narcotic requirements. Results. There were 54 patients in each group. Mean hospital stay was 3.5 days and 4.5 days (p = 0.004) for LipoB group and TEA group, respectively. There were no significant differences in perioperative complications, postoperative pain scores, or in narcotic utilization between LipoB group and TEA group. No acute toxicity related to LipoB was observed. Conclusions. Posterior intercostal nerve blockade using LipoB is safe and provides effective analgesia for patients undergoing thoracic surgery. It may be considered as a suitable alternative to TEA. (C) 2015 by The Society of Thoracic Surgeons
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收藏
页码:1953 / 1960
页数:8
相关论文
共 24 条
[1]   A Randomized Controlled Trial of Bupivacaine Through Intracostal Catheters for Pain Management After Thoracotomy [J].
Allen, Mark S. ;
Halgren, Lisa ;
Nichols, Francis C., III ;
Cassivi, Stephen D. ;
Harmsen, William S. ;
Wigle, Dennis A. ;
Shen, K. Robert ;
Deschamps, Claude .
ANNALS OF THORACIC SURGERY, 2009, 88 (03) :903-910
[2]  
[Anonymous], BMJ
[3]   Practice Guidelines for Acute Pain Management in the Perioperative Setting An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management [J].
Ashburn, Michael A. ;
Caplan, Robert A. ;
Carr, Daniel B. ;
Connis, Richard T. ;
Ginsberg, Brian ;
Green, Carmen R. ;
Lema, Mark J. ;
Nickinovich, David G. ;
Rice, Linda Jo .
ANESTHESIOLOGY, 2012, 116 (02) :248-273
[4]  
Bergese Sergio D, 2012, J Pain Res, V5, P107, DOI 10.2147/JPR.S30861
[5]   A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty [J].
Bramlett, Kenneth ;
Onel, Erol ;
Viscusi, Eugene R. ;
Jones, Kevin .
KNEE, 2012, 19 (05) :530-536
[6]   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 [J].
Davies, RG ;
Myles, PS ;
Graham, JM .
BRITISH JOURNAL OF ANAESTHESIA, 2006, 96 (04) :418-426
[7]   POSTOPERATIVE EPIDURAL BUPIVACAINE-MORPHINE THERAPY - EXPERIENCE WITH 4,227 SURGICAL CANCER-PATIENTS [J].
DELEONCASASOLA, OA ;
PARKER, B ;
LEMA, MJ ;
HARRISON, P ;
MASSEY, J .
ANESTHESIOLOGY, 1994, 81 (02) :368-375
[8]   Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy [J].
Detterbeck, FC .
ANNALS OF THORACIC SURGERY, 2005, 80 (04) :1550-1559
[9]   Effects of extended-release metoprolol succinate inpatients undergoing non-cardiac surgery (POISE trial):: a randomised controlled trial [J].
Devereaux, P. J. ;
Yang, Homer ;
Yusuf, Salim ;
Guyatt, Gordon ;
Leslie, Kate ;
Villar, Juan Carlos ;
Xavier, Denis ;
Chrolavicius, Susan ;
Greenspan, Launi ;
Pogue, Janice ;
Pais, Prem ;
Liu, Lisheng ;
Xu, Shouchun ;
Malaga, German ;
Avezum, Alvaro ;
Chan, Matthew ;
Montori, Victor M. ;
Jacka, Mike ;
Choi, Peter .
LANCET, 2008, 371 (9627) :1839-1847
[10]   A Comparison of the Analgesia Efficacy and Side Effects of Paravertebral Compared with Epidural Blockade for Thoracotomy: An Updated Meta-Analysis [J].
Ding, Xibing ;
Jin, Shuqing ;
Niu, Xiaoyin ;
Ren, Hao ;
Fu, Shukun ;
Li, Quan .
PLOS ONE, 2014, 9 (05)