Continuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications.
To evaluate the effects of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary complications, a randomized, double-blind, placebo-controlled study was conducted on 80 patients undergoing elective thoracotomy for pulmonary (n = 47) or oesophageal (n = 33) procedures. In patients who received continuous bupivacaine infusion, the requirement for intramuscular opiate and rectal diclofenac was less, the score on a visual linear analogue pain scale lower and recovery of pulmonary function more rapid than in saline-infused controls. Postoperative pulmonary complications occurred in 35% of the saline group, but only 10% of the patients with bupivacaine infusion (p < 0.01). In patients with chronic obstructive airways disease (COAD), the incidence of postoperative pulmonary complications was 54.5% in the saline group and only 4.5% in the bupivacaine group (p < 0.01). Among the patients without COAD there was no significant intergroup difference in such complications. We conclude that continuous extrapleural intercostal nerve block is effective for post-thoracotomy analgesia and reduces pulmonary complications of thoracotomy in patients with COAD.
Eng
J
J
Department of Thoracic Surgery, Bradford Royal Infirmary, England.
Sabanathan
S
S
D000698:Analgesia / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D003371:Cough / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007367:Intercostal Nerves; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D010919:Placebos; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D015656:Respiratory Mechanics / Q000502:physiology; D013908:Thoracotomy / Q000009:adverse effects; D014797:Vital Capacity / Q000502:physiology
D010919:Placebos; D002045:Bupivacaine