Intrapleural intercostal nerve block associated with mini-thoracotomy improves pain control after major lung resection.
OBJECTIVE
To prospectively assess the impact of intrapleural intercostal nerve block (IINB) associated with mini-thoracotomy on postoperative pain and surgical outcome after major lung resections.


METHODS
Between January 2004 and February 2005, we randomly assigned 120 consecutive patients undergoing mini-thoracotomy (10-13 cm) for major lung resections, to receive or not IINB from the 4th to the 8th space at the moment of thoracotomy using 20 ml (7.5 mg/ml) ropivacain injection at the dose of 4 ml for each space. Postoperative analgesia consisted of continuous intravenous infusion of tramadol (10 mg/h) and ketoralac tromethamine (3 mg/h) for 48 h for all patients.


RESULTS
The two groups (60 patients each) were comparable for age, sex, pulmonary function, type and duration of the procedure. Mortality and morbidity were 0% and 10%, respectively, for the IINB group and 3.3% and 15%, respectively, for the non-IINB group (p>0.05, NS). Mean postoperative pain measured by the 'Visual Analogue Scale' were as follows: 2.3+/-1 at 1 h, 2.2+/-0.8 at 12 h, 1.8+/-0.7 at 24 h, and 1.6+/-0.6 at 48 h for the IINB group; and 3.6+/-1.4 at 1 h, 3.4+/-2 at 12 h, 2.9+/-1.2 at 24 h, and 2.0+/-1 at 48 h for the non-IINB group. Differences were significant at 1 h, 12 h, 24 h, and 48 h (p<0.05). Mean postoperative hospital stay was 5.7 days in the IINB group and 6.5 days in the non-IINB group (p<0.05).


CONCLUSIONS
IINB associated with mini-thoracotomy reduces postoperative pain and contributes to improve postoperative outcome after major pulmonary resections.
D'Andrilli
Antonio
A
Department of Thoracic Surgery, University of Rome La Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
Ibrahim
Mohsen
M
Ciccone
Anna Maria
AM
Venuta
Federico
F
De Giacomo
Tiziano
T
Massullo
Domenico
D
Pinto
Giovanni
G
Rendina
Erino A
EA
D000368:Aged; D005260:Female; D006801:Humans; D007367:Intercostal Nerves; D007902:Length of Stay; D008171:Lung Diseases / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods