Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Canada.
Department of Anaesthesia, The Prince Charles Hospital, Brisbane, Australia.
Anaesth Intensive Care. 2023 Sep;51(5):348-358. doi: 10.1177/0310057X231172787. Epub 2023 Jun 20.
There are few data on current trends in pain management for thoracic surgery in Australia and New Zealand. Several new regional analgesia techniques have been introduced for these operations in the past few years. Our survey aimed to assess current practice and perceptions towards various modalities of pain management for thoracic surgery among anaesthetists in Australia and New Zealand. A 22-question electronic survey was developed and distributed in 2020 with the assistance of the Australian and New Zealand College of Anaesthetists Cardiac Thoracic Vascular and Perfusion Special Interest Group. The survey focused on four key domains-demographics, general pain management, operative technique, and postoperative approach. Of the 696 invitations, 165 complete responses were obtained, for a response rate of 24%. Most respondents reported a trend away from the historical standard of thoracic epidural analgesia, with a preference towards non-neuraxial regional analgesia techniques. If representative of anaesthetists in Australia and New Zealand more widely, this trend may result in less exposure of junior anaesthetists to the insertion and management of thoracic epidurals, potentially resulting in reduced familiarity and confidence in the technique. Furthermore, it demonstrates a notable reliance on surgically or intraoperatively placed paravertebral catheters as the primary analgesic modality, and suggests the need for future studies assessing the optimal method of catheter insertion and perioperative management. It also gives some insight into the current opinion and practice of the respondents with regard to formalised enhanced recovery after surgery pathways, acute pain services, opioid-free anaesthesia, and current medication selection.
关于澳大利亚和新西兰胸外科疼痛管理的当前趋势，数据有限。在过去的几年中，针对这些手术，已经引入了几种新的区域镇痛技术。我们的调查旨在评估澳大利亚和新西兰麻醉师对胸外科各种疼痛管理方式的当前实践和看法。我们使用澳大利亚和新西兰麻醉师学院心脏胸血管和灌注特别兴趣小组的协助，开发了一个包含 22 个问题的电子调查，并于 2020 年进行了分发。该调查侧重于四个关键领域：人口统计学、一般疼痛管理、手术技术和术后方法。在 696 份邀请中，有 165 份完整回复，回复率为 24%。大多数受访者报告称，他们的趋势偏离了历史上的胸硬膜外镇痛标准，更倾向于使用非神经轴突区域镇痛技术。如果这代表了更广泛的澳大利亚和新西兰麻醉师的趋势，那么这种趋势可能会导致初级麻醉师接触到胸硬膜外穿刺和管理的机会减少，从而可能导致对该技术的熟悉度和信心降低。此外，这表明对手术或术中放置的椎旁导管作为主要镇痛方式的明显依赖，并表明需要未来研究评估导管插入和围手术期管理的最佳方法。它还提供了一些关于受访者对术后强化康复途径、急性疼痛服务、无阿片类麻醉和当前药物选择的当前意见和实践的见解。
