G. Bolotin et al., The efficacy of intraoperative internal intercostal nerve block during video-assisted thoracic surgery on postoperative pain, ANN THORAC, 70(6), 2000, pp. 1872-1875
Citations number
16
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Background. Video-assisted thoracic surgery (VATS) is widely used for many
thoracic surgical procedures. Postoperative pain is less after VATS than af
ter conventional thoracic surgery, but is still significant. The objective
of this study was to assess the efficacy of thoracoscopic, internal interco
stal nerve block in alleviating immediate postoperative pain.
Methods. Thirty-two patients underwent VATS bilateral sympathectomy for the
treatment of hyperhidrosis. The patients were randomly divided into two gr
oups with similar demographic and preoperative physiologic parameters. Grou
p A (n = 16) was submitted to thoracoscopic, internal intercostal nerve blo
cks performed at T2, T3, and T4 intercostal levels using 3 cc of 0.5% bupiv
acain in each intercostal space. The injections were performed bilaterally,
immediately after the sympathectomy, through the same port. Group B (n = 1
6) underwent bilateral thoracic sympathectomy without the block. During the
immediate postoperative period, heart rate, blood pressure, respiratory ra
te, pain score, and analgesic requirements were monitored every 30 minutes.
Results. No morbidity was recorded in association with the thoracoscopic, i
nternal intercostal nerve block. The mean heart rates (77 +/- 6 vs 89 +/- 1
2 beats per minute, p < 0.001), respiratory rates (15 +/- 2 vs 18 +/- 3 res
pirations per minute, p < 0.01), pain score (1.9 +/- 0.6 vs 2.7 +/- 0.5, p
< 0.01), and postoperative analgesic requirements (20 +/- 18 vs 50 +/- 21 m
g pethidine HCL, p < 0.001) were significantly Lower in group A. There was
no significant difference in blood pressures.
Conclusions. Thoracoscopic, internal intercostal nerve block with bupivacai
n 0.5% during VATS is safe and effectively reduced the immediate postoperat
ive pain and analgesic requirements. (Ann Thorac Surg 2000;70:1872-5) (C) 2
000 by The Society of Thoracic Surgeons.