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.
Department of Thoracic Surgery, University of Rome La Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
Antonio
A
D'Andrilli
Mohsen
M
Ibrahim
Anna Maria
AM
Ciccone
Federico
F
Venuta
Tiziano
T
De Giacomo
Domenico
D
Massullo
Giovanni
G
Pinto
Erino A
EA
Rendina
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