The Efficacy and Safety of Epidural-Based Analgesia in a Case Series of Patients Undergoing Lung Transplantation

• Published in: Journal of cardiothoracic and vascular anesthesia 2015-02, Vol.29 (1), p.126-132
• Main Authors: Cason, Molly, MD, Naik, Ami, MD, Grimm, Joshua C., MD, Hanna, David, BS, Faraone, Lea, BS, Brookman, Jason C., MD, Shah, Ashish, MD, Hanna, Marie N., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; analgesia; Analgesia, Epidural - adverse effects; Analgesia, Epidural - trends; Anesthesia & Perioperative Care; complications; Critical Care; efficacy; epidural; Female; Humans; Lung transplant; Lung Transplantation - adverse effects; Lung Transplantation - trends; Male; Middle Aged; pain management; Pain Measurement - trends; Pain, Postoperative - diagnosis; Pain, Postoperative - prevention & control; Retrospective Studies; safety; Treatment Outcome; Young Adult
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2014.07.023

Objective Successful pain management after lung transplantation is critical to ensure adequate respiratory effort and graft expansion. The authors investigated whether thoracic epidural analgesia (TEA) provided adequate pain control after lung transplantation without added morbidity. Design Retrospective review. Setting University teaching hospital. Participants One hundred twenty-three patients who presented to this institution for lung transplantation from January 2008 to June 2013. Interventions Patient demographics, postoperative pain scores, and epidural-related complications were abstracted from the institutional electronic database. The authors used the previously validated Quality of Recovery (QoR) score and Visual Analog Scale (VAS) as measures of recovery. Measurements and Main Results Of the 123 patients who underwent lung transplantation in this time frame, 119 patients had thoracic epidurals placed for postoperative analgesia. The mean age was 49.4 years (range, 18–73), and 60 (50.4%) were male. The most common indications for transplant were pulmonary fibrosis (33.6%), cystic fibrosis (26.1%), and chronic obstructive pulmonary disease (20.2%). The median length of stay in the intensive care unit and duration of mechanical ventilation were 21 and 1.2 days, respectively. Eight (6.7%) patients experienced postoperative pulmonary compromise (eg, pneumonia, prolonged intubation). No serious complications were associated with TEA placement. On days 1, 3, and 7 after TEA placement, the mean QoR was 7.6, 9.4, and 9.7, and the mean VAS was 2.5, 2.1, and 2.0, respectively. Conclusions In this case series, the authors observed excellent analgesia and no serious complications associated with TEA. Therefore, an epidural-centric approach to pain control after lung transplantation should be considered in appropriate patients.