Postoperative analgesia in video-assisted thoracoscopy: the role of intercostal blockade.
OBJECTIVE
This study examined (1) the opioid and nonopioid requirement of patients undergoing video-assisted thoracoscopy (VATS) as a measure of postoperative pain and (2) whether percutaneous intercostal blockade might reduce morphine requirements and improve analgesia in VATS procedures.


METHODS
A combined retrospective and prospective study.


METHODS
A university teaching hospital.


METHODS
Patients undergoing VATS procedures.


METHODS
A retrospective analysis of 26 sequential patients; perioperative intercostal blockade with bupivacaine, either with or without dextran 40, in 26 prospective patients.


RESULTS
Retrospective: opioid and nonopioid analgesic requirements of 26 sequential patients who had undergone VATS surgery without intercostal blockade were determined from a study of the case records. Twenty-six additional patients undergoing VATS surgery by the same surgeon were randomly divided to receive either percutaneous intercostal nerve block using plain bupivacaine 0.375% or bupivacaine 0.375% in dextran 40. The duration of local anesthesia was assessed. Postoperative opioid and nonopioid analgesic requirements were compared with the retrospective group.


CONCLUSIONS
Postoperative morphine requirements after VATS surgery are considerable, with pleurectomy being the most painful procedure. Intercostal blockade with bupivacaine provided effective pain relief and a dramatic reduction in morphine requirements. This technique is recommended for VATS surgery, especially if day-case procedures are being contemplated.
Taylor
Ruth
R
Department of Anaesthesia, Bristol Royal Infirmary, Bristol, United Kingdom.
Massey
Simon
S
Stuart-Smith
Karen
K
D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003911:Dextrans / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007367:Intercostal Nerves; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted
D000700:Analgesics; D000779:Anesthetics, Local; D003911:Dextrans; D002045:Bupivacaine