Search Results (8)

An 8-month-old Standard Poodle was referred to a surgical specialist for suspected peripheral intravenous catheter (PIVC) embolism originating from the right cephalic vein. Upon removing the 20-gauge PIVC, the tip appeared to be 2 cm shorter. Radiographs were obtained for the localization of the PIVC embolism, but no abnormalities were seen. A computed tomography scan of the whole body was performed. PIVC embolism was observed due to a difference in Hounsfield units between the catheter tip and the surrounding lung parenchyma in the ventral aspect of the left caudal lung lobe. A left lateral thoracotomy in the seventh intercostal space was then performed, leading to the successful retrieval of the catheter tip while allowing the lung lobe to be spared. This case report describes a PIVC embolism migrating to the lung parenchyma and its successful surgical removal. Full article

Background: Although rarely performed, sternal resection for chondrosarcoma presents considerable anesthetic challenges, particularly in both immediate and long-term pain management. Method: This case study details the anesthetic protocol adopted for a 61-year-old male who underwent a sternal resection, chest wall reconstruction and muscle flap coverage due to chondrosarcoma. To optimize perioperative analgesia, a thoracic epidural catheter was placed preoperatively, combined intraoperatively with bilateral parasternal blocks targeting intercostal nerves at the resection margin. General anesthesia was tailored and paired with fluid restriction and minimal vasopressor doses to stabilize hemodynamics. Result: Postoperative recovery was marked by minimal discomfort, no need for systemic opioids, and early initiation of physiotherapy. At 12 months post-surgery, the absence of persistent pain or physical dysfunction suggested that the synergistic use of thoracic epidural and parasternal blocks offers effective control over both short-term and chronic pain following major chest wall surgery. The holistic integration of psychological support and an active rehabilitation regimen exemplified a biopsychosocial strategy, instrumental to the patient’s positive trajectory. Conclusions: This experience underscores the advantage of supplementing epidural anesthesia with parasternal nerve blocks in sternal resections, facilitating better outcomes and reducing systemic opioid use. Further studies involving broader patient populations are necessary to validate and refine this promising approach in preventing chronic pain in complex thoracic surgeries. Full article

(1) Background: The optimal management approach for adults with traumatic pneumothorax without haemothorax remains an area of debate. Specifically, there is lack of consensus as to whether insertion of a pigtail catheter is superior to a formal intercostal catheter in improving complication rates. (2) Methods: Medline, EMBASE, Cochrane Central, and the World Health Organisation International Clinical Trials Registry Platform databases were systematically searched for studies evaluating pigtail catheters compared to formal intercostal catheters for the management of traumatic pneumothorax. Investigative outcomes of interest included pain, duration management, failure, need for formal thoracoscopic surgery, need for supplemental oxygen, length of stay, infection and overall total complications. (3) Results: Three studies evaluating 280 patients were included in this analysis. There was no significant difference in total complications, rates of failure, length of stay or duration of management between pigtail catheters and formal intercostal catheters. This evidence was based on studies of low to moderate risk of bias with poor control for confounding factors. (4) Conclusions: This systematic review and meta-analysis demonstrates lack of evidence to suggest pigtail catheters are superior to formal intercostal catheter for traumatic pneumothorax. These findings may reflect a true absence of effect between either approach for this patient cohort or non-committal findings in light of limitations of the underlying evidence. Further prospective trials with larger sample sizes and control for confounders are required to validate the outcomes between these two modalities of treatment. Full article

Background/Objectives: Pain after video-assisted thoracoscopic surgery (VATS) leads to impaired postoperative recovery, possible side effects of opioid usage, and higher rates of chronic post-surgery pain (CPSP). Nevertheless, guidelines on perioperative pain management for VATS patients are lacking. The aim of this study was to analyze the effectiveness of intercostal catheters in combination with a single shot intraoperative intercostal nerve block (SSINB) in comparison to SSINB alone with respect to opioid consumption and CPSP. Methods: Patients receiving an anatomic VATS resection between 2019 and 2022 for primary lung cancer were retrospectively analyzed. A total of 75 consecutive patients receiving an ICC and SSINB and 75 consecutive patients receiving only SSINB were included in our database. After enforcing the exclusion criteria (insufficient documentation, external follow-ups, or patients receiving opioids on a fixed schedule; n = 9) 141 patients remained for further analysis. Results: The ICC and No ICC cohort were comparable in age, gender distribution, tumor location and hospital stay. Patients in the ICC cohort showed significantly less opioid usage regarding the extent (4.48 ± 6.69 SD vs. 7.23 ± 7.55 SD mg, p = 0.023), duration (0.76 ± 0.97 SD vs. 1.26 ± 1.33 SD days, p = 0.012) and frequency (0.90 ± 1.34 SD vs. 1.45 ± 1.51 SD times, p = 0.023) in comparison to the No ICC group. During the first nine months of oncological follow-up assessments, no statistical difference was found in the rate of patients experiencing postoperative pain, although a trend towards less pain in the ICC cohort was found. One year after surgery, the ICC cohort expressed significantly less often pain (1.5 vs. 10.8%, p = 0.035). Conclusions: Placement of an ICC provides VATS patients with improved postoperative pain relief resulting in a reduced frequency of required opioid administration, less days with opioids, and a reduced total amount of opioids consumed. Furthermore, ICC patients have significantly lower rates of CPSP one year after surgery. Full article

Background: Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic surgery units, with a special interest in opioid usage and strategies to avoid opioids. Methods: A questionnaire was designed to assess the use of regional anesthesia, postoperative pain medication and characteristics of individual pain management regimens. The questionnaire was sent to all thoracic surgery units in Austria, with nine out of twelve departments returning them. Results: All departments use regional anesthesia during the procedure. Four out of nine centers use epidural analgesia or an intercostal catheter for postoperative regional anesthesia in at least 50% of patients. Two departments follow an opioid restrictive regimen, five depend on the visual analogue scale (VAS) and two administer opioids on a fixed schedule. Three out of nine departments use NSAIDs on a fixed schedule. The most used medication is metamizole (eight out of nine centers; six on a fixed schedule, two depending on VAS) followed by piritramide (six out of nine centers; none as a fixed prescription). Conclusions: This study reflects the heterogeneity in postoperative pain treatment after VATS anatomic lung resections. All departments use some form of regional anesthesia in the perioperative period; prolonged regional anesthesia is not utilized uniformly to reduce opioid consumption, as suggested in enhanced recovery after surgery programs. More evidence is needed to optimize and standardize postoperative pain treatment. Full article

Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks. Full article

Introduction: There are no prospective studies looking at complications of pleural procedures. Previous British Thoracic Society Pleural audits and retrospective case series inform current practice. Incidence of any complication is between 1–15%. We sought to add to the existing literature and inform local practice with regards to intercostal drains and thoracocenteses. Methods: Local Caldicott approval was sought for a review of all inpatient adult pleural procedures coded as ‘T122 drainage of pleural cavity’ and ‘T124 insertion of tube drain into pleural cavity’. Those undergoing thoracocentesis (all with a Rocket 6 Fg catheter) and intercostal drain insertion (ICD, all with Rocket 12 Fg drain) were identified. Continuous variables are presented as mean (±range) and categorical variables as percentages where appropriate. Results: 1159 procedures were identified. A total of 199 and 960 were done for pneumothorax and effusions respectively. Mean age was 68.1 years (18–97). There were 280 thoracocenteses and 879 ICDs. Bleeding occurred in 6 (0.5%), all ICDs (clotting and platelets were within normal range; one patient was on aspirin and one on aspirin and clopidogrel). All settled except for one who had intercostal artery rupture needing cardiothoracic intervention (no anti-coagulation). Nine pneumothoraces occurred (0.78%) in seven ICDs and two aspirations). There were three definite pleural space infections (0.3%) with three ICDs. Fall out rates for ICDs were 35 (3%). Nine were not sutured, and out of those, seven inserted in the Accident and Emergency department, out of hours. All others ‘came out’ due to patient factors (previous quoted rates up to 14%). Surgical emphysema occurred in 43 (41 ICDs), 3.7%. Eight were due to fall outs and three required surgical intervention. There was no re-expansion pulmonary oedema nor direct deaths. Conclusions: Complication rates of ICD and thoracocenteses are low. Checklists might help to remind operators of the need for suturing. Limitations of this study are its retrospective nature and reliance on correct hospital coding. We are currently contributing to a prospective observational study on pleural complications. Full article

Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) affects patients’ recovery, postoperative complications, and length of stay (LOS). Despite its relevance, there are no guidelines on optimal perioperative pain management. This study aims to analyse the effects of an additional intercostal catheter (ICC) in comparison to a single shot intraoperative intercostal nerve block (SSINB). Methods: All patients receiving an anatomic VATS resection between June 2019 and May 2020 were analysed retrospectively. The ICC cohort included 51 patients, the SSINB cohort included 44 patients. Results: There was no difference in age, gender, comorbidities, or duration of surgery between cohorts. Pain scores on the first postoperative day, after chest drain removal, and highest pain score measured did not differ between groups. The overall amount of opioids (morphine equivalent: 3.034 mg vs. 7.727 mg; p = 0.002) as well as the duration of opioid usage (0.59 days vs. 1.25 days; p = 0.005) was significantly less in the ICC cohort. There was no difference in chest drain duration, postoperative complications, and postoperative LOS. Conclusions: Pain management with ICC reduces the amount of opioids and number of days with opioids patients require to achieve sufficient analgesia. In conclusion, ICC is an effective regional anaesthesia tool in postoperative pain management in minimally invasive thoracic surgery. Full article