Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to Thoracic Epidural Analgesia.
BACKGROUND
Pain relief using regional neuroaxial blockade is standard care for patients undergoing major thoracic surgery. Thoracic epidural analgesia (TEA) provides effective postoperative analgesia but has unwanted side effects, including hypotension, urinary retention, nausea, and vomiting, and is highly operator dependent. Single-shot intercostal nerve and paravertebral blockade have not been widely used because of the short duration of action of most local anesthetics; however, the recent availability of liposomal bupivacaine (LipoB) offers the potential to provide prolonged blockade of intercostal nerves (72 to 96 hours). We hypothesized that a five-level unilateral posterior intercostal nerve block using LipoB would provide effective analgesia for patients undergoing thoracic surgery.


METHODS
We identified patients who underwent lung resection using intraoperative LipoB posterior intercostal nerve blockade and retrospectively compared them with a group of patients who had TEA and who were matched for age, sex, type of surgery, and surgical approach. We analyzed perioperative morbidity, pain scores and narcotic requirements.


RESULTS
There were 54 patients in each group. Mean hospital stay was 3.5 days and 4.5 days (p = 0.004) for LipoB group and TEA group, respectively. There were no significant differences in perioperative complications, postoperative pain scores, or in narcotic utilization between LipoB group and TEA group. No acute toxicity related to LipoB was observed.


CONCLUSIONS
Posterior intercostal nerve blockade using LipoB is safe and provides effective analgesia for patients undergoing thoracic surgery. It may be considered as a suitable alternative to TEA.
Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas. Electronic address: drice@mdanderson.org.
David C
DC
Rice
Department of Anesthesia and Perioperative Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Juan P
JP
Cata
Department of Anesthesia and Perioperative Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Gabriel E
GE
Mena
Department of Anesthesia and Perioperative Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Andrea
A
Rodriguez-Restrepo
Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Arlene M
AM
Correa
Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Reza J
RJ
Mehran
D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007367:Intercostal Nerves; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures; D013997:Time Factors
D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine