Application of Continuous Wound-Infusion Catheters in Lung Transplantation: A Retrospective Data Analysis

• Published in: The Thoracic and cardiovascular surgeon Vol. 65; no. 5; p. 403
• Main Authors: Lenz, Nils, Hirschburger, Markus, Roehrig, Rainer, Menges, Thilo, Mueller, Matthias, Padberg, Winfried, Mann, Valesco
• Format: Journal Article
• Language: English
• Published: Germany 01.08.2017
• Subjects: Analgesia, Epidural - adverse effects; Analgesics, Opioid - administration & dosage; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Catheters, Indwelling; Humans; Intercostal Nerves; Lung Transplantation - adverse effects; Lung Transplantation - methods; Nerve Block - adverse effects; Nerve Block - instrumentation; Nerve Block - methods; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Patient Selection; Retrospective Studies; Risk Factors; Thoracotomy - adverse effects; Time Factors; Treatment Outcome; Ventilator Weaning
• ISSN: 1439-1902
• DOI: 10.1055/s-0036-1580621

Lung transplantation is the only treatment option for many patients with end-stage pulmonary disease. Therefore, postthoracotomy pain therapy is of vital interest. Thoracic epidural analgesia (EPI) is the "gold standard" for postthoracotomy pain, but especially in lung transplantation contraindications, and potential infectious complications limit its advantages. Under these circumstances surgically placed postthoracotomy catheter-assisted continuous paravertebral intercostal nerve block (PVB) could be of advantage.  We performed a retrospective cohort study of patients who underwent lung transplantation between 2005 and 2012. Groups were defined according to the type of postoperative pain therapy: PVB, EPI, and SYS (systemic analgesia). Total 44 patients were eligible.  Postoperative opioid requirement of the PVB and EPI group was comparable and less than that of the SYS group. Patients of the PVB group were weaned earlier from mechanical ventilation after lung transplantation.  The potency of postoperative pain therapy of EPI and PVB seemed to be comparable and superior to SYS. Considering the risks and benefits, PVB could be a better choice than EPI for postthoracotomy pain therapy, especially in lung transplantation.