Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: A randomized controlled trial

Zulfiqar Ahmed, Khalid Samad, Hameed Ullah, Zulfiqar Ahmed, Khalid Samad, Hameed Ullah

Abstract

Background: The main advantages of video assisted thoracoscopic surgery (VATS) include less post-operative pain, rapid recovery, less postoperative complications, shorter hospital stay and early discharge. Although pain intensity is less as compared to conventional thoracotomy but still patients experience upto moderate pain postoperatively. The objective of this study was to assess the efficacy and morphine sparing effect of intercostal nerve block in alleviating immediate post-operative pain in patients undergoing VATS.

Materials and methods: Sixty ASA I-III patients, aged between 16 to 60 years, undergoing mediastinal lymph node biopsy through VATS under general anaesthesia were randomly divided into two groups. The intercostal nerve block (ICNB group) received the block along with patient control intravenous analgesia (PCIA) with morphine, while control group received only PCIA with morphine for post-operative analgesia. Patients were followed for twenty four hours post operatively for intervention of post-operative pain in the recovery room and ward.

Results: The pain was assessed using visual analogue scale (VAS) at 1, 6, 12 and 24 hours. There was a significant decrease in pain score and morphine consumption in ICNB group as compared to control group in first 6 hours postoperatively. There was no significant difference in pain scores and morphine consumption between the two groups after 6 hours.

Conclusion: Patients receiving intercostal nerve block have better pain control and less morphine consumption as compared to those patients who did not receive intercostal nerve block in early (6 hours) post-operative period.

Keywords: Intercostal nerve block; patient control intravenous analgesia; video-assisted thoracoscopy; visual analog scale.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of visual analogue scale mean pain score with respect to time. (*P < 0.05) (Group A – intraoperative intercostal nerve blockade, Group B – control)

References

    1. Lewis RJ, Caccavale RJ, Bocage JP, Widmann MD. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy: A more patient-friendly oncologic resection. Chest. 1999;116:1119–24.
    1. Tovar EA. One-day admission for major lung resections in septuagenarians and octogenarians: A comparative study with a younger cohort. Eur J Cardiothorac Surg. 2001;20:449–53.
    1. Kaplan JA, Miller ED, Jr, gallagher EG., Jr Postoperative analgesia for thoracotomy patients. Anesth Analg. 1975;54:773–7.
    1. Bolotin G, Lazarovici H, Uretzky G, Zlotnick AY, Tamir A, Saute M. The efficacy of intraoperative internal intercostal nerve block during video-assisted thoracic surgery on postoperative pain. Ann Thorac Surg. 2000;70:1872–5.
    1. Tschernko EM, Hofer S, Bieglmayer C, Wisser W, Haider W. Early postoperative stress: Video-assisted wedge resection/lobectomy vs conventional axillary thoracotomy. Chest. 1996;109:1636–42.
    1. Soto RG, Fu ES. Acute pain management for patients undergoing thoracotomy. Ann Thorac Surg. 2003;75:1349–57.
    1. Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology. 1994;81:737–59.
    1. Taylor R, Massey S, Stuart-Smith K. Postoperative analgesia in video-assisted thoracoscopy: The role of intercostal blockade. J Cardiothorac Vasc Anesth. 2004;18:317–21.
    1. Benedetti F, Amanzio M, Casadio C, Cavallo A, Cianci R, Giobbe R, et al. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg. 1997;63:773–6.
    1. Sanjay OP, Prashanth P, Tauro DI. Intercostal nerve blockade versus thoracic epidural analgesia for post thoracotomy pain relief. Indian J Thorac Cardiovasc Surg. 2003;19:141–4.
    1. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89:409–23.
    1. Landreneau RJ, Hazelrigg SR, Mack MJ, Dowling RD, Burke D, Gavlick J, et al. Postoperative pain-related morbidity: Video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993;56:1285–9.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅