Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection.
BACKGROUND
Effective postoperative pain control for thoracic surgery is very important, not only because it reduces pulmonary complications but also because it accelerates the pace of recovery. Moreover, it increases patients' satisfaction with the surgery. In this study, we present a simple approach involving the safe placement of intercostal catheter (ICC) after single port video-assisted thoracoscopic surgery (VATS) anatomic resection and we evaluate postoperative analgesic function with and without it.


METHODS
We identified patients who underwent single port anatomic resection with ICC placed intraoperatively as a route for continuous postoperative levobupivacaine (0.5%) administration and retrospectively compared them with a group of single port anatomic resection patients without ICC. The operation time, postoperative day 0, 1, 2, 3 and discharge day pain score, triflow numbers, narcotic requirements, drainage duration and post-operative hospital stay were compared.


RESULTS
In total, 78 patients were enrolled in the final analysis (39 patients with ICC and 39 without). We found patients with ICC had less pain sensation numerical rating scale (NRS) on postoperative day 0, 1 (P=0.023, <0.001) and better triflow performance on postoperative day 1 and 2 (P=0.015, 0.032). In addition, lower IV form morphine usage frequency and dosage (P=0.009, 0.017), shorter chest tube drainage duration (P=0.001) and postoperative stay (P=0.005) were observed in the ICC group.


CONCLUSIONS
Continuous intercostal nerve blockade by placing an ICC intraoperatively provides effective analgesia for patients undergoing single port VATS anatomic resection. This may be considered a viable alternative for postoperative pain management.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Ming-Ju
MJ
Hsieh
Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Kuo-Cheng
KC
Wang
Department of Anesthesia, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Hung-Pin
HP
Liu
Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain.
Diego
D
Gonzalez-Rivas
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Ching-Yang
CY
Wu
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Yun-Hen
YH
Liu
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Yi-Cheng
YC
Wu
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Yin-Kai
YK
Chao
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Ching-Feng
CF
Wu
Single port VATS; anatomic resection; intercostal nerve block