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An assessment of the effectiveness of regional analgesia after VATS measured by an objective method for assessing testosterone, cortisol, α-amylase, sIgA, and β-endorphin levels — a randomised controlled trial
, 1, 1, 2, 1
Affiliations- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
- Chair and Department of Thoracic Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
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Abstract
Introduction: Thoracic surgeries are associated with intense postoperative pain. General opioid analgesia is still the main anaesthetic method. Due to the large number of opioid-induced side effects, alternative methods of pain relief are sought. One of them is the use of balanced analgesia, which consists of regional analgesia, non-opioid painkillers, and small doses of opioids.
Material and methods: The objective of this study was to assess the effectiveness of preoperative thoracic paravertebral block (ThPVB) in the treatment of postoperative pain after video-assisted thoracic surgery (VATS) by measuring hormone levels in blood serum or saliva. It was a randomised, open-label study conducted in a single university hospital setting between May 2018 and September 2019. In total, 119 patients were scheduled for elective video-assisted thoracic surgery. Performed interventions included: preoperative thoracic paravertebral block with 0.5% bupivacaine, followed by postoperative oxycodone combined with nonopioid analgesics. Follow-up period comprised first 24 hours and one, two, and six months after surgery. Main outcomes were measured by pain intensity assessed using the Numerical Rating Scale (NRS) and the levels of the following hormones: testosterone, cortisol, α-amylase activity, sIgA, and β-endorphin.
Results: A total of 119 patients were randomised into two groups and, of these, 49 were subsequently excluded from the analysis. The final analysis included 37 patients from the study group and 33 from the control group. There were no statistically significant differences in the analysed parameters the relative change T1–T0. There was a tendency towards statistical significance in the relative change T2–T0 in testosterone levels. At rest, no statistically significant differences were found between groups and time in the percentage of patients with NRS ≥ 1. During cough, the percentage of patients with NRS ≥ 1 was higher at T1 and T2 time points in the ThPVB group. Of the factors considered, only α-amylase levels statistically significantly increased the chance for higher NRS score after a month [OR = 1.013; 95% PU: 1.001–1.025; p < 0.01].
Conclusions: ThPVB is effective and safe for patients undergoing VATS. It can be an effective alternative for general anaesthesia using high doses of opioids.
Abstract
Introduction: Thoracic surgeries are associated with intense postoperative pain. General opioid analgesia is still the main anaesthetic method. Due to the large number of opioid-induced side effects, alternative methods of pain relief are sought. One of them is the use of balanced analgesia, which consists of regional analgesia, non-opioid painkillers, and small doses of opioids.
Material and methods: The objective of this study was to assess the effectiveness of preoperative thoracic paravertebral block (ThPVB) in the treatment of postoperative pain after video-assisted thoracic surgery (VATS) by measuring hormone levels in blood serum or saliva. It was a randomised, open-label study conducted in a single university hospital setting between May 2018 and September 2019. In total, 119 patients were scheduled for elective video-assisted thoracic surgery. Performed interventions included: preoperative thoracic paravertebral block with 0.5% bupivacaine, followed by postoperative oxycodone combined with nonopioid analgesics. Follow-up period comprised first 24 hours and one, two, and six months after surgery. Main outcomes were measured by pain intensity assessed using the Numerical Rating Scale (NRS) and the levels of the following hormones: testosterone, cortisol, α-amylase activity, sIgA, and β-endorphin.
Results: A total of 119 patients were randomised into two groups and, of these, 49 were subsequently excluded from the analysis. The final analysis included 37 patients from the study group and 33 from the control group. There were no statistically significant differences in the analysed parameters the relative change T1–T0. There was a tendency towards statistical significance in the relative change T2–T0 in testosterone levels. At rest, no statistically significant differences were found between groups and time in the percentage of patients with NRS ≥ 1. During cough, the percentage of patients with NRS ≥ 1 was higher at T1 and T2 time points in the ThPVB group. Of the factors considered, only α-amylase levels statistically significantly increased the chance for higher NRS score after a month [OR = 1.013; 95% PU: 1.001–1.025; p < 0.01].
Conclusions: ThPVB is effective and safe for patients undergoing VATS. It can be an effective alternative for general anaesthesia using high doses of opioids.
Keywords
NRS; video-assisted thoracic surgery; acute pain; regional anaesthesia; testosterone; cortisol; α-amylase; sIgA; β-endorphin
About this articleTitle
An assessment of the effectiveness of regional analgesia after VATS measured by an objective method for assessing testosterone, cortisol, α-amylase, sIgA, and β-endorphin levels — a randomised controlled trial
Journal
Issue
Article type
Original paper
Pages
133-142
Published online
2021-01-11
Page views
1189
Article views/downloads
768
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2021;72(2):133-142.
Keywords
NRS
video-assisted thoracic surgery
acute pain
regional anaesthesia
testosterone
cortisol
α-amylase
sIgA
β-endorphin
Authors
Szymon Bialka
Magdalena Sliwczynska
Aleksandra Marciniak
Damian Czyzewski
Hanna Misiolek
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