TY - JOUR
T1 - Enhanced recovery pathways in thoracic surgery from Italian VATS Group
T2 - Perioperative analgesia protocols
AU - Piccioni, Federico
AU - Segat, Matteo
AU - Falini, Stefano
AU - Umari, Marzia
AU - Putina, Olga
AU - Cavaliere, Lucio
AU - Ragazzi, Riccardo
AU - Massullo, Domenico
AU - Taurchini, Marco
AU - Naja, Carlo Del
AU - Droghetti, Andrea
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.
AB - Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.
KW - Pain management
KW - Regional analgesia
KW - Video-assisted thoracoscopic surgery (VATS)
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U2 - 10.21037/jtd.2017.12.86
DO - 10.21037/jtd.2017.12.86
M3 - Review article
AN - SCOPUS:85043360524
VL - 10
SP - S555-S563
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
SN - 2072-1439
ER -