Avoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance
(2021) In Regional Anesthesia and Pain Medicine 46(6). p.532-534- Abstract
Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive... (More)
Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.
(Less)
- author
- Bachman, Sarah A. ; Lundberg, Johan LU and Herrick, Michael
- organization
- publishing date
- 2021-06-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- analgesia, anesthesia, local, pain, postoperative, regional anesthesia
- in
- Regional Anesthesia and Pain Medicine
- volume
- 46
- issue
- 6
- pages
- 3 pages
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85102000583
- pmid:33653876
- ISSN
- 1098-7339
- DOI
- 10.1136/rapm-2020-102352
- language
- English
- LU publication?
- yes
- id
- 5b978c40-44d9-4c61-96d2-d0334c7950ba
- date added to LUP
- 2022-05-12 08:39:54
- date last changed
- 2024-12-27 09:33:32
@article{5b978c40-44d9-4c61-96d2-d0334c7950ba,
abstract = {{<p>Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available. </p>}},
author = {{Bachman, Sarah A. and Lundberg, Johan and Herrick, Michael}},
issn = {{1098-7339}},
keywords = {{analgesia; anesthesia; local; pain; postoperative; regional anesthesia}},
language = {{eng}},
month = {{06}},
number = {{6}},
pages = {{532--534}},
publisher = {{BMJ Publishing Group}},
series = {{Regional Anesthesia and Pain Medicine}},
title = {{Avoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance}},
url = {{http://dx.doi.org/10.1136/rapm-2020-102352}},
doi = {{10.1136/rapm-2020-102352}},
volume = {{46}},
year = {{2021}},
}