Cargando…

Pain management after robot-assisted minimally invasive esophagectomy

BACKGROUND: Adequate pain control after open esophagectomy is associated with reduced complications, earlier recovery and higher patient satisfaction. While further developing surgical procedures like robot-assisted minimally invasive esophagectomy (RAMIE) it is relevant to adapt postoperative pain...

Descripción completa

Detalles Bibliográficos
Autores principales: Rosner, Ann Kristin, van der Sluis, Pieter C., Meyer, Lena, Wittenmeier, Eva, Engelhard, Kristin, Grimminger, Peter P., Griemert, Eva-Verena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988548/
https://www.ncbi.nlm.nih.gov/pubmed/36895408
http://dx.doi.org/10.1016/j.heliyon.2023.e13842
_version_ 1784901592796889088
author Rosner, Ann Kristin
van der Sluis, Pieter C.
Meyer, Lena
Wittenmeier, Eva
Engelhard, Kristin
Grimminger, Peter P.
Griemert, Eva-Verena
author_facet Rosner, Ann Kristin
van der Sluis, Pieter C.
Meyer, Lena
Wittenmeier, Eva
Engelhard, Kristin
Grimminger, Peter P.
Griemert, Eva-Verena
author_sort Rosner, Ann Kristin
collection PubMed
description BACKGROUND: Adequate pain control after open esophagectomy is associated with reduced complications, earlier recovery and higher patient satisfaction. While further developing surgical procedures like robot-assisted minimally invasive esophagectomy (RAMIE) it is relevant to adapt postoperative pain management. The primary question of this observational survey was whether one of the two standard treatments, thoracic epidural analgesia (TEA) or intravenous patient-controlled analgesia (PCA), is superior for pain control after RAMIE as the optimal pain management for these patients still remains unclear. Use of additional analgesics, changes in forced expiratory volume in 1 s (FEV1), postoperative complications and duration of intensive care and hospital stay were also analyzed. METHODS: This prospective observational pilot study analyzed 50 patients undergoing RAMIE (postoperative PCA with piritramide or TEA using bupivacaine; each n = 25). Patient reported pain using the numeric rating scale score and differences in FEV1 using a micro spirometer were measured at postoperative day 1, 3 and 7. Additional data of secondary endpoints were collected from patient charts. RESULTS: Key demographics, comorbidity, clinical and operative variables were equivalently distributed. Patients receiving TEA had lower pain scores and a longer-lasting pain relief. Moreover, TEA was an independent predictive variable for reduced length of hospital stay (HR -3.560 (95% CI: −6.838 to −0.282), p = 0.034). CONCLUSIONS: Although RAMIE leads to reduced surgical trauma, a less invasive pain therapy with PCA appears to be inferior compared to TEA in case of sufficient postoperative analgesia and length of hospital stay. According to the results of this observational pilot study analgesia with TEA provided better and longer-lasting pain relief compared to PCA. Further randomized controlled trials should be conducted to evaluate the optimal postoperative analgesic treatment for RAMIE.
format Online
Article
Text
id pubmed-9988548
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-99885482023-03-08 Pain management after robot-assisted minimally invasive esophagectomy Rosner, Ann Kristin van der Sluis, Pieter C. Meyer, Lena Wittenmeier, Eva Engelhard, Kristin Grimminger, Peter P. Griemert, Eva-Verena Heliyon Research Article BACKGROUND: Adequate pain control after open esophagectomy is associated with reduced complications, earlier recovery and higher patient satisfaction. While further developing surgical procedures like robot-assisted minimally invasive esophagectomy (RAMIE) it is relevant to adapt postoperative pain management. The primary question of this observational survey was whether one of the two standard treatments, thoracic epidural analgesia (TEA) or intravenous patient-controlled analgesia (PCA), is superior for pain control after RAMIE as the optimal pain management for these patients still remains unclear. Use of additional analgesics, changes in forced expiratory volume in 1 s (FEV1), postoperative complications and duration of intensive care and hospital stay were also analyzed. METHODS: This prospective observational pilot study analyzed 50 patients undergoing RAMIE (postoperative PCA with piritramide or TEA using bupivacaine; each n = 25). Patient reported pain using the numeric rating scale score and differences in FEV1 using a micro spirometer were measured at postoperative day 1, 3 and 7. Additional data of secondary endpoints were collected from patient charts. RESULTS: Key demographics, comorbidity, clinical and operative variables were equivalently distributed. Patients receiving TEA had lower pain scores and a longer-lasting pain relief. Moreover, TEA was an independent predictive variable for reduced length of hospital stay (HR -3.560 (95% CI: −6.838 to −0.282), p = 0.034). CONCLUSIONS: Although RAMIE leads to reduced surgical trauma, a less invasive pain therapy with PCA appears to be inferior compared to TEA in case of sufficient postoperative analgesia and length of hospital stay. According to the results of this observational pilot study analgesia with TEA provided better and longer-lasting pain relief compared to PCA. Further randomized controlled trials should be conducted to evaluate the optimal postoperative analgesic treatment for RAMIE. Elsevier 2023-02-17 /pmc/articles/PMC9988548/ /pubmed/36895408 http://dx.doi.org/10.1016/j.heliyon.2023.e13842 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
Rosner, Ann Kristin
van der Sluis, Pieter C.
Meyer, Lena
Wittenmeier, Eva
Engelhard, Kristin
Grimminger, Peter P.
Griemert, Eva-Verena
Pain management after robot-assisted minimally invasive esophagectomy
title Pain management after robot-assisted minimally invasive esophagectomy
title_full Pain management after robot-assisted minimally invasive esophagectomy
title_fullStr Pain management after robot-assisted minimally invasive esophagectomy
title_full_unstemmed Pain management after robot-assisted minimally invasive esophagectomy
title_short Pain management after robot-assisted minimally invasive esophagectomy
title_sort pain management after robot-assisted minimally invasive esophagectomy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988548/
https://www.ncbi.nlm.nih.gov/pubmed/36895408
http://dx.doi.org/10.1016/j.heliyon.2023.e13842
work_keys_str_mv AT rosnerannkristin painmanagementafterrobotassistedminimallyinvasiveesophagectomy
AT vandersluispieterc painmanagementafterrobotassistedminimallyinvasiveesophagectomy
AT meyerlena painmanagementafterrobotassistedminimallyinvasiveesophagectomy
AT wittenmeiereva painmanagementafterrobotassistedminimallyinvasiveesophagectomy
AT engelhardkristin painmanagementafterrobotassistedminimallyinvasiveesophagectomy
AT grimmingerpeterp painmanagementafterrobotassistedminimallyinvasiveesophagectomy
AT griemertevaverena painmanagementafterrobotassistedminimallyinvasiveesophagectomy