Intercostal catheter analgesia is more efficient vs. intercostal nerve blockade for post-thoracotomy pain relief

Kristek, Jozo and Kvolik, Slavica and Šakić, Kata and Has, Borislav and Prlić, Lidija (2007) Intercostal catheter analgesia is more efficient vs. intercostal nerve blockade for post-thoracotomy pain relief. Collegium Antropologicum, 31 (2). pp. 561-566. ISSN 0350-6134

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Abstract

A pain after thoracotomy may result in a postoperative hypoventilation and lead to atelectases and pneumonia. This study was aimed to compare two analgesic regimens after posterolateral thoracotomy. 80 patients (40-70 years) undergoing thoracotomy were randomized to intercostal catheter analgesia (group A, n = 40) and intercostal nerve block (group B, n = 40). Patients in group A were given 20 mL of 0.5% bupivacaine injections twice a day by intercostal catheter. Intercostal nerve blockade was performed using 5 mL of 0.5% bupivacaine. Intercostal nerve in thoracotomy wound, nerves below and above thoracotomy wound was also injected. PaO2, PaCO2, FVC, FEV1 and visual analog pain scale (VAS) were obtained preoperatively, 24, 48 and 72 hours after operation. Postoperative complications were recorded at the patient discharge. Differences between groups were calculated using Mann-Whitney, KW test and chi square test. The arterial blood gas analyses did not show statistically significant change in any group and time according to the baseline values. FVC and FEV1 decreased significantly in both groups at first postoperative day according to baseline measurements. Patients in B group had significantly higher FEV1 values in the third postoperative day (73.05 +/- 11.25 in A vs. 83.50 +/- 9.17 in B group, p < 0.05). Intercostal catheter analgesia resulted in significantly lower postoperative VAS scores and reduced opioid requirement as compared to intercostal nerve blockade. No differences in the postoperative complications were observed between groups.

Abstract in Croatian

Bol nakon torakotomije može uzrokovati poslijeoperacijsku hipoventilaciju i dovesti do atelektaze i upale pluća. Cilj ove studije bio je usporediti dvije metode poslijeoperacijske analgezije nakon posterolateralne torakotomije. 80 bolesnika u dobi od 40 do 70 godine koji su bili podvrgnuti torakotomiji podijeljeno je dvije skupine. Skupina A (n=40) primila je putem katetera u međurebrenom prostoru 20 mL 0.5% bupivakaina. Skupini B (n=40) je injekcijom 5 mL 0.5% bupivakaina u svaki međurebreni prostor učinjena blokada živaca u prostoru u kojem je učinjen operacijski rez, te blok živca iznad i ispod operacijskog reza. PaO2, PaCO2, FVC, FEV1 i intenzitet boli putem vizualne analogne ljestvice (VAS) su se mjerili prije operacije, 24, 48 i 72 sata iza operacije. Poslijeoperacijske komplikacije zabilježene su pri otpustu. Statistička analiza razlika među skupinama vršila se testom Mann-Whitney, Kruskall-Wallis i 2 testom. Vrijednosti analiza plinova u arterijskoj krvi nisu se statistički značajno razlikovale među skupinama i u odnosu na početne vrijednosti. FVC i FEV1 prvog su poslijeoperacijskog dana značajno smanjeni u odnosu na prijeoperacijske vrijednosti kod obje skupine. Trećeg poslijeoperacijskog dana FEV1 bio je značajno veći kod bolesnika u grupi B (73.05±11.25 u skupini A i 83.50±9.17 u skupini B, p<0.05). Intenzitet boli statistički značajno je smanjen pri uporabi analgezije putem interkostalnog katetera u odnosu na blok međurebrenih živaca, a smanjena je i potrošnja opioida. Učestalost poslijeoperacijskih komplikacija bila je jednaka u obje skupine.

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