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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1999 June;40(3):445-56

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Post-thor­a­cot­o­my spir­o­met­ric ­lung func­tion: the ­effect of anal­ge­sia. A ­review

Richardson J., Sabanathan S.†, Shah R. 

From the Departments of Anaesthetics and Thoracic Surgery Bradford Royal Infirmary, England


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Background. The ­effects of post­thor­a­cot­o­my ­pain man­age­ment on pul­mo­nary func­tion has ­been ­assessed.
Methods. All English lan­guage pub­li­ca­tions involv­ing pros­pec­tive, ran­dom­ised, con­trolled stud­ies of ­patients under­go­ing pos­te­ro-lat­er­al thor­a­cot­o­my inci­sions ­where per­i­op­er­a­tive spi­rom­e­try had ­been stud­ied ­were includ­ed. The ­mean post­op­er­a­tive per­cent­age pres­er­va­tion of pre­op­er­a­tive ­lung func­tion was record­ed or deter­mined for ­each anal­ge­sic reg­i­men.
Results. 55 stud­ies ­were ­reviewed ­with a ­total of 1762 ­patients. The ­most effec­tive anal­ge­sic meth­od in ­terms of pres­er­va­tion of spir­o­met­ric func­tion was par­a­ver­te­bral anal­ge­sia, ­patients hav­ing approx­i­mate­ly 75% of ­their pre­op­er­a­tive val­ues in the ­first 48 ­hours ­after sur­gery. Most oth­er tech­niques e.g. inter­cos­tal ­nerve ­blocks, epi­du­ral ­local anaesthet­ics or ­local anaesthet­ic-opi­ate com­bi­na­tions pro­duced approx­i­mate­ly a 55% pres­er­va­tion by 48 ­hours. Interpleural anal­ge­sia was the ­least effec­tive, ­with a ­mean of 35% pres­er­va­tion by 48 ­hours, ­less ­even ­than ­TENS or cryoa­nal­ge­sia.
Conclusions. A thor­a­cot­o­my poten­tial­ly pro­duc­es a ­marked reduc­tion in post­op­er­a­tive pul­mo­nary func­tion and the ­choice of ­pain man­age­ment has ­major impli­ca­tions. Attenuation of post­thor­a­cot­o­my pul­mo­nary dys­func­tion by effec­tive anal­ge­sia ­should be pro­vid­ed for all ­patients under­go­ing ­chest sur­gery. Simply pro­vid­ing effec­tive anal­ge­sia on its own with­out ­regard to pul­mo­nary func­tion is inad­e­quate. Spirometric mon­i­tor­ing ­should be stan­dard in all tho­rac­ic ­units and is essen­tial for objec­tive com­par­i­sons of the effi­ca­cy of dif­fer­ent meth­ods of ­pain man­age­ment.

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