Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial.

BACKGROUND: Use of minimally invasive surgical techniques for lung resection surgery (LRS), such as video-assisted thoracoscopy (VATS), has increased in recent years. However, there is little information about the best anesthetic technique in this context. This surgical approach is associated with a lower intensity of postoperative pain, and its use has been proposed in programs for enhanced recovery after surgery (ERAS). This study compares the severity of postoperative complications in patients undergoing LRS who have received lidocaine intraoperatively either intravenously or via paravertebral administration versus saline. METHODS/DESIGN: We will conduct a single-center randomized controlled trial involving 153 patients undergoing LRS through a thoracoscopic approach. The patients will be randomly assigned to one of the following study groups: intravenous lidocaine with more paravertebral thoracic (PVT) saline, PVT lidocaine with more intravenous saline, or intravenous remifentanil with more PVT saline. The primary outcome will be the comparison of the postoperative course through Clavien-Dindo classification. Furthermore, we will compare the perioperative pulmonary and systemic inflammatory response by monitoring biomarkers in the bronchoalveolar lavage fluid and blood, as well as postoperative analgesic consumption between the three groups of patients. We will use an ANOVA to compare quantitative variables and a chi-squared test to compare qualitative variables. DISCUSSION: The development of less invasive surgical techniques means that anesthesiologists must adapt their perioperative management protocols and look for anesthetic techniques that provide good analgesic quality and allow rapid rehabilitation of the patient, as proposed in the ERAS protocols. The administration of a continuous infusion of intravenous lidocaine has proven to be useful and safe for the management of other types of surgery, as demonstrated in colorectal cancer. We want to know whether the continuous administration of lidocaine by a paravertebral route can be substituted with the intravenous administration of this local anesthetic in a safe and effective way while avoiding the risks inherent in the use of regional anesthetic techniques. In this way, this technique could be used in a safe and effective way in ERAS programs for pulmonary resection. TRIAL REGISTRATION: EudraCT, 2016-004271-52; ClinicalTrials.gov, NCT03905837 . Protocol number IGGFGG-2016 version 4.0, 27th April 2017.

Effectiveness of guided imagery relaxation on levels of pain and depression in patients diagnosed with fibromyalgia.

AIM: The aim of this study was to evaluate the effects of guided imagery as a nursing intervention for pain management and depression in patients diagnosed with fibromyalgia. BACKGROUND: Many studies support the use of guided imagery to improve patient outcomes. Guided imagery has been used for different purposes and it is thought to be an effective intervention for people suffering from nonmalignant pain. DESIGN: A 2-group quasi-experimental study was conducted during 8 weeks by the University of Nursing in Almeria (Spain). METHODS: Patients diagnosed with fibromyalgia aged 18 to 70 years (n = 60) were randomly assigned to a guided imagery group (n = 30) or a control group (n = 30). The outcomes measures were scores for pain with the McGill Pain Questionnaire long form (MPQ-LF) and the Visual Analogue Scale (VAS) and depression with the Beck Depression Inventory and the VAS for depression. The effects were examined at baseline, postintervention (4th week), and at the end of the study (8th week). RESULTS: Treatment efficacy was analyzed by using a t test for paired samples. Temporal changes in the scores were examined by using a 2-way repeated-measures analysis of variance. The treatment group reported statistically significantly lower levels of pain (P < .046) and depression (P < .010) than the control group at the week 4 evaluation. A statistically significant effect on pain as measured by the daily VAS diary was also found in the experimental group. At week 8, no significant differences were found for pain. CONCLUSION: Patients diagnosed with fibromyalgia may benefit from this nursing intervention in terms of relieving pain and depression. Guided imagery relaxation therapy could be incorporated as part of fibromyalgia treatment to promote health among people with fibromyalgia. RELEVANCE TO CLINICAL PRACTICE: Guided imagery as a nursing intervention can alleviate pain and depression in patients diagnosed with fibromyalgia.