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. Post-operative pain is less after VATS than after conventional thoracic surgery, but is still significant. The objective of this study was to assess the efficacy of thoracoscopic, internal intercostal 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 groups with similar demographic and preoperative physiologic parameters. Group A (n = 16) was submitted to thoracoscopic, internal intercostal nerve blocks performed at T2, T3, and T4 intercostal levels using 3 cc of 0.5% bupivacain in each intercostal space. The injections were performed bilaterally, immediately after the sympathectomy, through the same port. Group B (n = 16) underwent bilateral thoracic sympathectomy without the block. During the immediate postoperative period, heart rate, blood pressure, respiratory rate, pain score, and analgesic requirements were monitored every 30 minutes.


RESULTS
No morbidity was recorded in association with the thoracoscopic, internal intercostal nerve block. The mean heart rates (77 +/- 6 vs 89 +/- 12 beats per minute, p < 0.001), respiratory rates (15 +/- 2 vs 18 +/- 3 respirations 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 mg 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 bupivacain 0.5% during VATS is safe and effectively reduced the immediate postoperative pain and analgesic requirements.
Bolotin
G
G
Department of Cardiothoracic Surgery, Carmel Medical Center, The Technion, Israel Institute of Technology, Haifa. bolotin@netvision.net.il
Lazarovici
H
H
Uretzky
G
G
Zlotnick
A Y
AY
Tamir
A
A
Saute
M
M
D000293:Adolescent; D000328:Adult; D002045:Bupivacaine; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D007367:Intercostal Nerves / Q000187:drug effects*; D008297:Male; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D013562:Sympathectomy; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
D002045:Bupivacaine