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Review
. 2023 Sep 28;15(9):5099-5111.
doi: 10.21037/jtd-23-241. Epub 2023 Sep 1.

Analgesia in esophagectomy: a narrative review

Minke L Feenstra  1   2   3   4 , Mark I van Berge Henegouwen  1   3   4 , Markus W Hollmann  2 , Jeroen Hermanides #  2 , Wietse J Eshuis #  1   3   4
Affiliations
Review

Analgesia in esophagectomy: a narrative review

Minke L Feenstra et al. J Thorac Dis. .

Abstract

Background and objective: Optimal pain management for esophagectomy facilitates prevention of postoperative complications such as pneumonia, but also chronic pain. Historically, multimodal intravenous analgesia was employed. In the last decades, regional anesthesia including epidural and paravertebral analgesia is frequently used. In this narrative review, we provide a comprehensive overview of the available evidence for the different analgesia regimens for esophagectomy.

Methods: A search was conducted in the PubMed/MEDLINE database in November 2022. Only reports in English or Dutch were included. Editorials or articles lacking full text were excluded. A review of different analgesia regimens after esophagectomy is provided.

Key content and findings: Epidural analgesia (EA) was suggested to reduce postoperative pneumonia and prevent chronic postsurgical pain (CPSP) as compared to opioid-based systemic analgesia and was considered the gold standard of pain management for esophagectomy. In the last decades, the side-effects of EA became more evident. Next to mild or moderate side-effects such as hypotension and urinary retention, several reports emphasized the incidence of serious neurologic complications to be much higher than estimated before. In addition, minimally invasive surgery fostered that other regional analgesia (RA) techniques are potential alternatives for EA. Paravertebral catheter placement can be performed under videoscope view during the thoracic phase of esophagectomy, making it a safe and easily placed block. Evidence on the effectiveness of erector spinae plane block (ESPB) is limited in this context.

Conclusions: Several analgesia regimens after esophagectomy are described. EA is most common, however paravertebral analgesia is a good alternative. Other techniques are also gaining ground but randomized clinical trials are lacking. Future studies should focus on the efficacy of paravertebral and erector spinae blocks for postoperative pain management for esophagectomy.

Keywords: Esophagectomy; analgesia; epidural; paravertebral.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-241/coif). MLF, JH and WJE report funding from ZonMW for the PEPMEN trial. MIvBH is consultant for Viatris, Johnson & Johnson, Alesi Surgical, Bbraun and Medtronic, and received unrestricted research grants from Stryker. He also received a research grant from ZonMWfor the PEPMEN trial. All fees paid to institution. MWH has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Thoracoscopic view of pleura.
See this image and copyright information in PMC

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