The efficacy of intraoperative internal intercostal nerve block during video-assisted thoracic surgery on postoperative pain

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.