Post-thoracotomy pain and pulmonary function--comparison of intermittent intercostal bupivacaine vs intravenous pethidine.
OBJECTIVE
In a prospective, observer-blind study, 50 patients scheduled for posterolateral thoracotomy were investigated to compare the effects of intermittent intercostal extrapleural bupivacaine (n = 25) and intravenous pethidine (n = 25) on post-thoracotomy pain and pulmonary function. The severity of chest pain (objectified by the use 5-point scale of Prince Henry) and changes in spirometric values [forced vital capacity (FVC), forced expired volume in 1 s (FEV1) and FEV1/FVC] were monitored during the first three postoperative days. Because intravenous pethidine was used to supplement pain relief in the patients who received intercostal analgesia, total pethidine used was compared to that administered to patients in the intravenous pethidine group.


RESULTS
There were no statistical significant differences regarding patient demographics in both groups. No complications occurred. There was no significant difference between mean pain scores in the first postoperative day, but in the second and third postoperative days and also in the whole first 72 post-operative hours, pain scores were significantly higher in the intravenous group than the intercostal group. The postoperative decrease in FVC and FEV1 was significantly less with intercostal bupivacaine compared with the intravenous pethidine. There was no significant intergroup difference in the post- to pre-operative FEV1/FVC ratio. The total amount of the pethidine received by the patients was significantly higher in the intravenous group than the intercostal group.


CONCLUSIONS
Intermittent intercostal nerve block with bupivacaine appears to be a promising, safe and reliable technique in the management of post-thoracotomy pain. Use of intercostal bupivacaine could significantly reduce or even eliminate the postoperative need for systemic narcotics.
Ghafouri
Ali
A
Department of General and Thoracic Surgery, Shariati Teaching Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Movafegh
Ali
A
Nasr-Esfahani
Mehran
M
Gholamrezanezhad
Ali
A
Madhkhan
Sepide
S
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007275:Injections, Intravenous; D007367:Intercostal Nerves; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013908:Thoracotomy; D016896:Treatment Outcome; D014797:Vital Capacity
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008614:Meperidine; D002045:Bupivacaine