Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark.
Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
J Cardiothorac Vasc Anesth. 2022 Dec;36(12):4378-4385. doi: 10.1053/j.jvca.2022.08.003. Epub 2022 Aug 12.
The risks and benefits of epidural analgesia have been studied extensively, but information regarding many other aspects of epidural catheter insertion is limited. The authors aimed to add information regarding procedural pain, procedure duration, failure rates, and the effect of experience to the ongoing discussion on this procedure.
A prospective observational study.
A Danish tertiary hospital.
Patients scheduled to undergo video-assisted thoracic surgery.
Epidural catheter insertion in 173 patients undergoing video-assisted thoracic surgery for lung cancer.
The authors recorded the time required for the epidural insertion procedure, the attempts used, insertion level, access use, patient position, placement technique used, and the designation of the physician placing the catheter. Furthermore, the authors asked the patients to evaluate the expected procedural pain, and after the procedure the authors asked them to evaluate the actual level of pain experienced. Six and 24 months after discharge, the authors examined persistent sequelae by using questionnaire assessments. The median procedure duration was 13 minutes, with 75% of the catheters placed within 22 minutes. Actual procedure-related pain (mean score [M] = 3.5, SD = 2.0) was significantly (p < 0.0001) less than that expected before the procedure (M = 4.9, SD = 2.0). The patients' expected pain, attempts required for successful catheter placement, and approach used to access the epidural space significantly affected the actual procedure-related pain (p = 0.001, p ≤ 0.003, and p = 0.023, respectively). Persistent pain and sensory disturbances were observed in 11% and 4% of the patients, respectively, after 6 months and in 6% and 4% of the patients, respectively, after 2 years.
In this study, the authors examined several lesser-known aspects of epidural procedures. The use of epidural analgesia as part of the pain management plan after surgery requires a more complex evaluation instead of merely discussing the possibility of procedural infections, hematomas, or neurologic injuries. The procedure time, patients' expected and experienced pain related to the procedure, and the potential long-term side effects should be a part of the decision-making process.
硬膜外镇痛的风险和益处已经得到了广泛的研究，但关于硬膜外导管插入术许多其他方面的信息有限。作者旨在为该手术的持续讨论增加有关程序疼痛、程序持续时间、失败率和经验影响的信息。
前瞻性观察性研究。
丹麦一家三级医院。
计划接受电视辅助胸腔镜手术的患者。
对 173 例接受电视辅助胸腔镜手术治疗肺癌的患者进行硬膜外导管插入术。
作者记录了硬膜外插入程序所需的时间、使用的尝试次数、插入水平、进入方式、患者体位、使用的放置技术以及放置导管的医生的指定。此外，作者询问患者预期的程序疼痛，并在程序后询问他们实际经历的疼痛程度。出院后 6 个月和 24 个月，作者通过问卷调查评估持续的后遗症。程序的中位持续时间为 13 分钟，75%的导管在 22 分钟内放置。实际程序相关疼痛（平均得分 [M] = 3.5，标准差 [SD] = 2.0）明显低于术前预期（M = 4.9，SD = 2.0）（p < 0.0001）。患者预期的疼痛、成功放置导管所需的尝试次数和进入硬膜外空间的方法显著影响实际程序相关疼痛（p = 0.001，p ≤ 0.003 和 p = 0.023，分别）。在 6 个月时，分别有 11%和 4%的患者出现持续性疼痛和感觉障碍，在 2 年后，分别有 6%和 4%的患者出现持续性疼痛和感觉障碍。
在这项研究中，作者检查了硬膜外程序的几个鲜为人知的方面。将硬膜外镇痛作为术后疼痛管理计划的一部分，需要更复杂的评估，而不仅仅是讨论手术过程中感染、血肿或神经损伤的可能性。手术时间、患者对程序的预期和实际疼痛以及潜在的长期副作用应成为决策过程的一部分。
