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Change in “Gold Standard” of Thoracic Epidural in Thoracic Surgery

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Anesthesia in Thoracic Surgery

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Abstract

The development of less invasive regional techniques and the evolution of thoracoscopic approaches have led to questioning the epidural pre-eminent role in thoracic surgery.

Despite the new and less invasive techniques of regional anesthesia boosted with advanced technology such as ultrasound, the role of epidural analgesia for both video-assisted thoracoscopy and open thoracotomy continues to be supported by current evidence.

On the other hand, although thoracoscopic approaches (and robotic surgery) are used with increasing frequency, they have not resulted in the expected favorable impact in terms of reducing the pain caused by the procedure.

Thoracic surgery has evolved during the twentieth century from open approaches to minimally invasive surgery, currently leading to the development of fast track surgery in thoracic surgery. The evolution of anesthesia and in particular regional anesthesia techniques, as well as the new concepts like preventive anesthesia and multimodal anesthesia has been a fundamental step in the development of thoracic surgery.

The current trend in all thoracic surgery approaches (although still underutilized) is the paravertebral blockade, without forgetting the interfascial blocks, which mark the current tendency, but both techniques are not free from risks. Thoracic epidural block remains the technique of choice for a large group of anesthesiologists for different reasons.

The choice of the technique (thoracic epidural block or paravertebral block) should be based on the experience of the anesthesiologist, the familiarity with the procedure, the clinical and anatomical particulars of the patient and a multimodal analgesic management plan. Other techniques such as interfascial blocks have their own space as techniques of choice depending on the type of surgical procedure.

Current evidence precludes recommending one technique over the other given the good analgesic profiles of both.

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Author information

Authors and Affiliations

  1. Valencia University Medical School, Valencia, Spain

    José A. De Andrés

  2. Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, Valencia, Spain

    José A. De Andrés & Javier E. Morales

  3. Istanbul Medical Faculty, Department of Anaesthesiology, Istanbul University, Istanbul, Turkey

    Mert Şentürk

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  1. José A. De Andrés
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  2. Javier E. Morales
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Editors and Affiliations

  1. Consorcio Hospital General Universitario, Valencia, Spain

    Manuel Granell Gil

  2. Istanbul Medical Faculty, Department of Anaesthesiology, Istanbul University, Istanbul, Turkey

    Mert Şentürk

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De Andrés, J.A., Morales, J.E., Şentürk, M. (2020). Change in “Gold Standard” of Thoracic Epidural in Thoracic Surgery. In: Granell Gil, M., Şentürk, M. (eds) Anesthesia in Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-28528-9_13

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  • DOI: https://doi.org/10.1007/978-3-030-28528-9_13

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