Incidence rate of chronic pain after 1.5-2 years of thoracotomy between paravertebral block versus epidural block: a cohort study.

Paravertebral block and epidural block are frequently employed for post-thoracotomy pain relief. It is not clear which postoperative analgesia method is effective for the chronic pain after the postoperative long term progress. Our hypothesis was that paravertebral block would be more effective than epidural block for chronic pain 1.5-2 years after thoracotomy. A cohort study investigating postoperative pain was performed in lung cancer patients undergoing thoracotomy between the ages of 20-80 year-old, employed for another randomized controlled trial. In previously study, the patients were randomly allocated into either the epidural block or paravertebral block group (n = 36/group). Patients in each group received the respective block placement with continuous 0.2% ropivacaine infusion at 5 ml/h. The patients completed a telephone observational survey using the EQ-5D-5L at 1.5-2 years. Forty-eight patients, 23 in the epidural block group and 25 in the paravertebral block group, were included in the final analysis. Quality of life scores at 1.5-2 postoperative years was similar in both groups. Mean scores ± standard deviation and 95% confidence interval were 0.899 ± 0.081 (0.705-0.938) in the epidural block group and 0.905 ± 0.079 (0.713-0.938) in the paravertebral block group, respectively, p = 0.81. The incidence rate of chronic postsurgical pain was eight patients; four in the epidural block group (17.4%) and four in the paravertebral block group (16.0%). There was no difference in incidence rate of long-term chronic postsurgical pain at 1.5-2 years after thoracotomy between the both groups. Our result will be used for further study protocols.

Fibrinogen levels measured by the dry hematology method are lower than those measured by the Clauss method under a high concentration of heparin.

The activity of fibrinogen has been reported to decrease soon after the onset of major bleeding and to be an important determinant of the final extent of bleeding and postoperative outcome. A device that measures the perioperative fibrinogen level using the dry hematology (DH) method has recently become available. The aim of this study was to compare perioperative fibrinogen levels measured by the DH method with those measured by the conventional Clauss method and to assess the effects of heparin on these measurements. The study included 206 samples from 36 patients undergoing major surgery who received high-dose heparin (HH group, 23 samples), low-dose heparin (LH group, 57 samples), or no heparin (C group, 126 control samples). Each sample was measured using the DH and Clauss methods. After excluding samples outside the effective measurement range, the three study groups (HH group, n=23; LH group, n=49; C group, n=115) were compared. The mean fibrinogen level measured by the DH method in the HH group (87.9 ± 3.1%) was significantly lower than that measured by the Clauss method. There were no significant differences between the fibrinogen measurements obtained by the two methods between the LH and C groups. In patients on high-dose heparin, the mean fibrinogen level measured by the DH method was significantly lower than that measured by the Clauss method. When hemorrhage requires emergency treatment, a method that can measure the fibrinogen level rapidly is important. The DH method may be useful for decision-making with regard to perioperative coagulation factor replacement.

[Comparison of Perioperative Outcomes for Esophageal Cancer: Thoracoscopic Versus Thoracotomic Esophagectomy].

BACKGROUND: In our hospital, thoracoscopic surgery in the prone position for esophageal cancer has been performed since 2013. To assess the invasiveness of thoracoscopic esophagectomy in the prone position, we conducted a retrospective observational study after IRB approval. METHODS: After some patients were removed for procedural reasons, 21 patients of thoracoscopic esoph- agectomy (group A, thoracoscopy group) were com- pared with 28 patients with thoracotomic esophagec- tomy (group B, thoracotomy group). We examined : operation time, amount of bleeding, percentage of blood transfused patients, intraoperative fluid balance, length of time from the end of operation to extubation, length of stay in intensive care unit (ICU) and hospital, and long-term intubation rate (> 72 hr). RESULTS: The thoracoscopy group showed less bleeding (mean, group A, 560 g ; group B, 1,243 g, P< 0.01), a lower percentage of blood transfused patients (group A, 14% ; group B, 64%, P<0.01), lower intra- operative fluid balance (median, group A, 3,046 ml ; group B, 4,215 ml, P<0.05), shorter length of stay in ICU (mean, group A, 2.4days ; group B, 3.7days, P< 0.01) and lower long-term intubation rate (>72 hr) (group A, 0% ; group B, 32%, P<0.01) than those of the thoracotomy group. CONCLUSIONS: This study showed that the thoraco- scopic esophagectomy in the prone position is poten- tially less invasive than thoracotomic surgery. Further study based on a larger number of patients is required to confirm this finding.