A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy
. (2011) A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy. British Journal of Anaesthesia, Vol.106 (No.3). pp. 364-370. ISSN 0007-0912
WRAP_Naidu_pneumonectomy.pdf - Submitted Version - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Official URL: http://dx.doi.org/10.1093/bja/aeq379
Background Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven.
Methods The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication.
Results The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P=0.02) by stepwise logistic regression analysis.
Conclusions An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RD Surgery|
|Divisions:||Faculty of Medicine > Warwick Medical School|
|Library of Congress Subject Headings (LCSH):||Lungs -- Surgery, Paravertebral anesthesia|
|Journal or Publication Title:||British Journal of Anaesthesia|
|Publisher:||Oxford University Press|
|Page Range:||pp. 364-370|
|Access rights to Published version:||Restricted or Subscription Access|
1. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth 2006;96(4):418-26.
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