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Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis.

Morris SA, Izatt MT, Adam CJ, Labrom RD, Askin GN - Scoliosis (2013)

Bottom Line: A retrospective study was designed to present the authors' technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime.Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83.One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method.

View Article: PubMed Central - HTML - PubMed

Affiliation: QUT/Mater Paediatric Spine Research Group, Queensland University of Technology and Mater Research, Level 2, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia. m.izatt@qut.edu.au.

ABSTRACT

Background: Thoracoscopic anterior scoliosis instrumentation is a safe and viable surgical option for corrective fusion of progressive adolescent idiopathic scoliosis (AIS) and has been performed at our centre on 205 patients since 2000. However, there is a paucity of literature reporting on or examining optimum methods of analgesia following this type of surgery. A retrospective study was designed to present the authors' technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime.

Methods: Records for 32 patients who underwent thoracoscopic anterior correction for AIS were reviewed. All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Patient's perceptions of their pain control was measured using the visual analogue pain scale scores which were recorded before and after local anaesthetic administration and the quantity and time of day that any other analgesia was taken, were also recorded.

Results: 28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method.

Conclusions: Local anaesthetic administration via an intrapleural catheter is a safe and effective method of analgesia following thoracoscopic anterior scoliosis correction. Post-operative pain following anterior thoracic scoliosis surgery can be reduced to 'mild' levels by combined analgesia regimes.

No MeSH data available.


Related in: MedlinePlus

Histogram demonstrating the frequency that each possible pain score was reported throughout the hospital stay, before and after administration of the local anaesthetic bolus following thoracoscopic anterior spinal fusion surgery (total 230 boluses).
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Figure 4: Histogram demonstrating the frequency that each possible pain score was reported throughout the hospital stay, before and after administration of the local anaesthetic bolus following thoracoscopic anterior spinal fusion surgery (total 230 boluses).

Mentions: Pain scores significantly decreased following administration of an intrapleural bolus (p < 0.0001) with the overall mean pain score decreasing from 3.66 to 1.83. Figure 4 gives the frequency distribution of each pain score before and after administration of a local anaesthetic bolus, clearly showing the shift toward lower pain scores which occurs post-bolus. The mean pain scores for all patients during the first four post-operative days are shown in Figure 5.


Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis.

Morris SA, Izatt MT, Adam CJ, Labrom RD, Askin GN - Scoliosis (2013)

Histogram demonstrating the frequency that each possible pain score was reported throughout the hospital stay, before and after administration of the local anaesthetic bolus following thoracoscopic anterior spinal fusion surgery (total 230 boluses).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3842798&req=5

Figure 4: Histogram demonstrating the frequency that each possible pain score was reported throughout the hospital stay, before and after administration of the local anaesthetic bolus following thoracoscopic anterior spinal fusion surgery (total 230 boluses).
Mentions: Pain scores significantly decreased following administration of an intrapleural bolus (p < 0.0001) with the overall mean pain score decreasing from 3.66 to 1.83. Figure 4 gives the frequency distribution of each pain score before and after administration of a local anaesthetic bolus, clearly showing the shift toward lower pain scores which occurs post-bolus. The mean pain scores for all patients during the first four post-operative days are shown in Figure 5.

Bottom Line: A retrospective study was designed to present the authors' technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime.Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83.One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method.

View Article: PubMed Central - HTML - PubMed

Affiliation: QUT/Mater Paediatric Spine Research Group, Queensland University of Technology and Mater Research, Level 2, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia. m.izatt@qut.edu.au.

ABSTRACT

Background: Thoracoscopic anterior scoliosis instrumentation is a safe and viable surgical option for corrective fusion of progressive adolescent idiopathic scoliosis (AIS) and has been performed at our centre on 205 patients since 2000. However, there is a paucity of literature reporting on or examining optimum methods of analgesia following this type of surgery. A retrospective study was designed to present the authors' technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime.

Methods: Records for 32 patients who underwent thoracoscopic anterior correction for AIS were reviewed. All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Patient's perceptions of their pain control was measured using the visual analogue pain scale scores which were recorded before and after local anaesthetic administration and the quantity and time of day that any other analgesia was taken, were also recorded.

Results: 28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal due to leakage; there were no other associated complications with the intermittent intrapleural analgesia method.

Conclusions: Local anaesthetic administration via an intrapleural catheter is a safe and effective method of analgesia following thoracoscopic anterior scoliosis correction. Post-operative pain following anterior thoracic scoliosis surgery can be reduced to 'mild' levels by combined analgesia regimes.

No MeSH data available.


Related in: MedlinePlus