Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter.
OBJECTIVE
No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area.


METHODS
Prospective observational cohort. Forty-eight consecutive patients received a standardized regimen consisting of paracetamol, non-steroidal anti-inflammatory drug and gabapentin. Further, surgeons performed a single-shot paravertebral block (PVB) at five levels (15 ml of 0.5% bupivacaine) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h(-1). Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days.


RESULTS
Forty-eight patients, mean age 64 years (CI: 61-68), were included. The mean time for the PVB and ICC placement was 5 min (CI: 4.7-5.9). The mean pain score at rest using a numerical rating scale (NRS, 0-10) was <3 for 1-16 h and decreased from 4.7 to 1.7 (NRS day 1-4, getting out of bed). The ICC was removed with the drain in 48/73/92% on day 1/2/3 after surgery. The median day of discharge was 3 (interquartile range 2-4) with >85% of patients reporting satisfactory or very satisfactory pain treatment all days.


CONCLUSIONS
Acute pain after VATS lobectomy may be adequately controlled using a multimodal non-opioid regime including PVB and an ICC. The low pain scores and reduced time used inserting the ICC may present an alternative to continuous epidural analgesia or conventional PVB.
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark. wildgaard@thoracotomy.eu
Kim
K
Wildgaard
Rene H
RH
Petersen
Henrik J
HJ
Hansen
Hasse
H
Møller-Sørensen
Thomas K
TK
Ringsted
Henrik
H
Kehlet
D000082:Acetaminophen / Q000008:administration & dosage; D000368:Aged; D000588:Amines / Q000008:administration & dosage; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002406:Catheterization, Peripheral / Q000379:methods; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D010865:Pilot Projects; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
D000588:Amines; D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D004338:Drug Combinations; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin