1. Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery
- Author
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Stefano Addesa, Umberto Lucangelo, Valeria Moro, Gaia Baldo, Marzia Umari, Enrico Lena, Stefano Lovadina, Valentina Carpanese, Umari, Marzia, Carpanese, Valentina, Moro, Valeria, Baldo, Gaia, Addesa, Stefano, Lena, Enrico, Lena, Stefano, and Lucangelo, Umberto
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Postoperative analgesia ,Thoracic epidural ,Humans ,Medicine ,Respiratory function ,Loco-regional anaesthesia ,Chronic pain syndrome ,Pneumonectomy ,Acetaminophen ,Acute postoperative pain ,Analgesics ,Pain, Postoperative ,Thoracic Surgery, Video-Assisted ,business.industry ,Nerve Block ,Chronic pain syndromes ,Multimodal therapy ,General Medicine ,Perioperative ,Analgesics, Opioid ,Tolerability ,Cardiothoracic surgery ,Anesthesia ,Video-assisted thoracoscopic surgery ,Neuropathic pain ,Nerve block ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended. Loco-regional techniques such as the thoracic epidural and peripheral blocks can be performed. Several adjuvants have been employed with varying degrees of success both intravenously and in combination with local anesthetics. Opioids with different pharmacodynamic and pharmacokinetic profiles can be used, either through continuous infusion or on demand. Non-opioid analgesics are also beneficial. Finally, perioperative gabapentinoids may be implemented to prevent the onset of chronic neuropathic pain.
- Published
- 2017
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