title: [Postoperative pain management in video-assisted thoracic surgery using a continuous unilateral intercostal analgesia].
abstract: BACKGROUND
  Optimal pain management after video-assisted thoracic surgery (VATS) remains an open issue. We prospectively studied the analgesic effect of intercostal analgegia (ICA) by comparison with epidural analgesia.
  
  
  METHODS
  Twenty-two patients undergoing VATS procedures were randomly divided into ICA (n = 8) or epidural (n = 14) group. Postoperatively 2 ml x hr(-1) of 0.2% ropivacaine was delivered continuously through intercostal or epidural catheter. Moreover, each group received the equal dose of fentanyl (0.25 x μg(-1). kg(-1) x hr(-1)) intravenously or epidurally. When no pain relief was achieved, iv fentanyl was given as a rescue. Requirement of additional fentanyl and pain score using a visual analogue scale (VAS) were documented for 19 hours.
  
  
  RESULTS
  The mean pain scores at rest, mobilization and with coghing were slightly higher in the ICA group. Total additional dose of iv fentanyl was significantly different between the groups (ICA 147 ± 41 vs Epidural 39 ± 15 μg; P = 0.015). Pain scores and fentanyl requirements spread over the lower range. The mean of VAS in ICA group was less than 5 even at coughing, suggesting clinically irrelevant.
  
  
  CONCLUSIONS
  In patients with coagulopathy, multimodal approach using intercostal analgesia supplemented by intravenous patient-controlled analgesia may be an alternative to epidural analgesia for postoperative pain management.
authors: Asami
authors: A
authors: Machino
authors: Masaki
authors: M
authors: Wakamatsu
authors: Takeshi
authors: T
authors: Kaida
authors: Hiroko
authors: H
authors: Hirano
authors: Yasuichiro
authors: Y
authors: Mori
authors: Saeko
authors: S
authors: Yamazaki
authors: Ai
authors: A
authors: Takahashi
authors: Sin
authors: S
authors: Haku
authors: Shouichi
authors: S
authors: Sugaya
authors: Kouji
authors: K
authors: Kuroda
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl; D006801:Humans; D007262:Infusions, Intravenous; D007367:Intercostal Nerves; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine