Perioperative analgesia for the prolepsis of persistence of post-thoracotomy chronic neuropathic pain
1Anesthesiology department, GONK "OI AG. ANARGYROI", Athens, Greece
2Department of Nursing, School of Health & Welfare Sciences, UNIWA, Athens, Greece
3Department of Economics, Laboratory of Economics & Health Management, School of Economics, Business & International Studies, University of Piraeus, MSc. State & Public Policy (Department of Management Science), Department of Political Science & Public Administration, School of NOPE, EKPA, BSc. Of Social Policy & Social Anthropology, Panteion University of Social & Political Sciences, PPC SA, former Deputy Governor of GNA KAT, former Chairman of the Board KEKYKAMEA Cyclades, Athens, Greece
4Thoracic surgery department, GONK “OI AG. ANARGYROI”, Athens, Greece
DOI: 10.22514/sv.2021.177 Vol.17,Issue S1,September 2021 pp.32-32
Submitted: 26 August 2021 Accepted: 06 September 2021
Published: 15 September 2021
Abstract: Proper perioperative analgesic management of Thoracic surgery cases constitutes a primary factor for the successful outcome of the surgery, having created the ideal conditions for both the thoracic surgeon and the anesthesiologist, but mainly for the avoidance of postoperative pain for the patient. 5%-67% of thoracic surgery cases reports post thoracotomy pain syndrome that can persist for up to 20 years.
Purpose: To give prominence to the benefits of analgesics for the patient undergoing thoracic surgery after having received appropriate perioperative treatment and starts analgesic protection from the time preceding surgical incision to the patient’s complete recovery, as far as prevention of chronic neuropathic pain is concerned. Complete analgesic protection presupposes the interdisciplinary collaboration of the surgeon and the anesthesiologist with the patient.
Materials & methods: Thorough review of scientific literature in scientific databases (PubMed, Scopus, SignaVitae) concerning perioperative analgesia in thoracotomies.
Results: In our effort to prevent the persistence of Chronic Neuropathic Pain, we always take into consideration the fact that thoracotomy patients suffer from respiratory complications/uneasy breathing with invasive analgesia techniques. Therefore, we remain alert to reduce the use of opioids and their adverse effects on those patients. Major analgesic outcomes and avoidance of persistence of chronic neuropathic pain can be achieved with the following procedure: (1) Intravenous administration of non-steroidal anti-inflammatories, paracetamol, dexamethasone 8 mg, NMDA receptor antagonist (Ketamine 30 mg) before incision as well as local infusion of Ropivacaine 2% solution. (2) Intravenous infusion of lidocaine, fentanyl, remifentanil, morphine, tramadol, Mg, ketamine, during surgery by adjusting doses per patient and operative time. (3) Particular caution is suggested in the immediate postoperative period so as to avoid transition from acute postoperative pain to chronic neuropathic pain. Our armamentarium includes paracetamol, tramadol, dexketoprofen, oxycodone per os, PCA morphine, pain busters (paired drainage catheters with elastomeric pumps) of ropivacaine 2%, patch lidocaine and thoracic epidural analgesia with ropivacaine pumps and intercostal block nerve conduction. A medical record of the postoperative analgesic course of our patients is kept and completed by our medical and nursing staff.
Conclusions: Perioperative analgesia is our key concern in all thoracic surgeries, so as to prevent post thoracotomy pain syndrome. For the purpose of this concern, we administer analgesic treatment on all surgery stages as well as keep postoperative analgesic record.
Dionysia Boura,Eirini Anastassopoulou,Paraskevi Koufopoulou,Nikolaos Anastasiou,Katsipoulakis Antonios,Lambropoulou Konstantina. Perioperative analgesia for the prolepsis of persistence of post-thoracotomy chronic neuropathic pain. Signa Vitae. 2021. 17(S1);32-32.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.