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• 10643

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10655

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    P1.07-012 - Collaborative multimodal pain management strategy for patients with non-small cell lung cancer submitted to thoracotomy (ID 1272)

    09:30 - 09:30  |  Author(s): X. Bataller
    • Abstract

    Background
    Relieving the intense pain associated with a thoracotomy incision improves patient well-being and pulmonary function, resulting in a more comfortable and ambulatory patient. Epidural analgesia and opioids have been classically employed to treat post-thoracotomy pain (“Gold Standard”), however these techniques have important secondary effects and drawbacks. Pain management strategies have evolved within the last years and significant advances have been achieved with the appearance of multimodal pain treatment. This new concept might be safe and efficacious in controlling post-thoracotomy pain and reducing the amount of systemic opioids consumed.

    Methods
    From 2007 to present date we have incorporated into our general thoracic surgery protocol a collaborative multimodal post-thoracotomy pain management strategy involving Thoracic Surgery, Anaesthesiology and Physiotherapy Departments. Patients eligible for this protocol were those scheduled for a thoracotomy for non-small cell lung cancer resection. Two sorts of thoracotomies were employed depending on the tumour location: Anterior Thoracotomy (AT) for tumours in the upper or middle lobe, and Postero-lateral thoracotomy (PT) for tumours in the lower lobe. At the end of surgery a paravertebral catheter (PC) was inserted under direct vision in the thoracic paravertebral space at the level of incision. Postoperatively patients received 300 mg/day of local anaesthetic (ropivacaine) through the PC combined with an intravenous non-steroidal anti-inflammatory drug (NSAID) (metamizole 2gr) every 6 hours and daily Transcutaneous Electrical Nerve Stimulation (TENS) sessions. A subcutaneous opioid (meperidine) was employed as rescue drug. Drugs dosages were controlled by the Anaesthesiology Department. The level of pain was measured with the visual analogic scale (VAS) at 1, 6, 24, 48 and 72 h after surgery. The need of meperidine as rescue drug and secondary effects were also recorded.

    Results
    A total of 270 patients entered the protocol. We did not register secondary effects in relation to the PC, NSAID or TENS. Thirty-five patients (13%) needed meperidine as rescue drug. Mean VAS values were the following: all the cases (n=270): 4.9+/-2.0, AT (n=150): 4.3+/-2.1, PT (n=120): 5.8+/-1.8. VAS 1 hour: AT 2.9, PT 4.3; VAS 6 hours: AT 6.7, PT 7.5; VAS 24 hours: AT 6.0, PT: 6.8; VAS 48 hours: AT 4.0, PT 6.0, VAS 72 hours: AT 3.0, PT: 4.7. Patients submitted to AT experienced less pain than those with PT in mean and at any time (p< 0.01).

    Conclusion
    Paravertebral block is an effective alternative to epidural analgesia in the management of post-thoracotomy pain. The analgesic scheme combining paravertebral block (PVB) through a PC placed by the thoracic surgeon, NSAID and TENS performed by the physiotherapist has proven to be effective for postoperative pain control after thoracotomy. Inasmuch as surgical extirpation of lung cancers remains the best hope of survival for many patients, a multimodal postoperative pain management plan avoiding the use of epidural analgesia and opioids is feasible and provides and optimal pain management.