title: The efficacy and safety of epidural-based analgesia in a case series of patients undergoing lung transplantation.
abstract: 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.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  One hundred twenty-three patients who presented to this institution for lung transplantation from January 2008 to June 2013.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Molly
authors.initials: M
authors.lastname: Cason
authors.affiliation: Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Ami
authors.initials: A
authors.lastname: Naik
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institution.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: University of Maryland, School of Medicine, College Park, MD.
authors.forename: David
authors.initials: D
authors.lastname: Hanna
authors.affiliation: Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Lea
authors.initials: L
authors.lastname: Faraone
authors.affiliation: Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Brookman
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institution.
authors.forename: Ashish
authors.initials: A
authors.lastname: Shah
authors.affiliation: Division of Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, MD. Electronic address: mhanna9@jhmi.edu.
authors.forename: Marie N
authors.initials: MN
authors.lastname: Hanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000639:trends; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lung transplant; analgesia; complications; efficacy; epidural; pain management; safety