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Intercostal nerve blockade versus thoracic epidural analgesia for post thoracotomy pain relief

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Post thoractomy pain is a major source of concern in the postoperative period. The purpose of this study was to evaluate the effectiveness of intraoperative temporary intercostal nerve blockade versus thoracic epidural analgesia for control of post thoracotomy pain.

Methods

40 patients undergoing elective pulmonary resection through a postero lateral thoractomy were randomly allocated to receive epidural analgesia using 0.25% bupivicaine (Group A, n=20) or temporary intercostal nerve blockade using 0.25% bupivicaine (Group B, n=20). Adequacy of analgesia was assessed over a period of 24 hours using a visual analogue score and an observer verbal ranking scale.

Results

Pain scores were similar in both the groups for the first 4 hours after surgery. Thereafter, the pain scores were significantly higher (p<0.05) in Group B as compared to Group A for the remainder of the observation period. There was significantly higher (p<0.01) usage, of nonsteroidal analgesic consumption in Group B. No neurological complications were encountered, in both the study groups.

Conclusion

We conclude that in the early postoperative period there is no significant difference in pain relief in both the techniques but there after, epidural analgesia significantly reduces post thoracotomy pain.

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References

  1. Sabanathan S, Eng J, Mearns AJ. Alteration in respiratory mechanics following thoractomy. J R Coll Surg Edinb 1990; 35: 144–50.

    PubMed  CAS  Google Scholar 

  2. Ballantyne JC, Carr DB, de Ferranti S. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cimulative meta-analyses of randomized, controlled trials. Anesth Analg 1998; 86: 598–612.

    Article  PubMed  CAS  Google Scholar 

  3. Craig DB. Postoperative recovery of pulmonary function. Anesth Analg 1981; 60: 46–52.

    PubMed  CAS  Google Scholar 

  4. Kaplan JA, Miller ED, Gallagher EGJ. Postoperative analgesia for thoractomy patients. Anesth Analg 1975; 54: 773–77.

    PubMed  CAS  Google Scholar 

  5. Logas WG, El-Baz N, El-Ganzouri A. Continuous thoracic epidual analgesia for postoperative pain relief following thoractomy: a randomized prospective study. Anesthesia 1987; 67: 787–91.

    Article  CAS  Google Scholar 

  6. Sanjay OP, Kadam VR, Menezes J, Prashanth P, Tauro DI. Thoracic epidural infusions for post thoractomy pain relief: a clinical study to compare the efficacy of fentanyl-bupivicaine mixtures versus fentanyl alone. Ind J Thorac Cardiovasc Surg 2003; 19: 113–18.

    Google Scholar 

  7. Sabanathan S, Smith PJB, Pradan GN, Hashimi M, Eng JB, Mearns AJ. Continous intercostal nerve block for pain relief after thoractomy. Ann Thorac Surg 1988; 46: 425–26.

    Article  PubMed  CAS  Google Scholar 

  8. Kaiser AM, Zollinger A, De Lorenzi D, Largiader, F, Weder W. Prospective, randomized comparison of extrapleural versus epidural analgesia for post thoractomy pain. Ann Thorac Surg 1998; 66: 367–73.

    Article  PubMed  CAS  Google Scholar 

  9. Sabanathan S, Mearns AJ, Smith PJB. Efficacy of continuous extrapleural intercostals nerve block on post thoracotomy pain and pulmonary mechanics. Br J Surg 1990; 77: 221–25.

    Article  PubMed  CAS  Google Scholar 

  10. Deneuville M, Bisserier A, Regnard JF, Chevalier M, Levasseur P, Herve P. Continuous intercostals and analgesia with 0.5% bupivicaine after thoractomy: a randomized study. Ann Thorac Surg 1993; 55: 381–85.

    Article  PubMed  CAS  Google Scholar 

  11. Takamori S, Yoshida S, Hayashi A, Matsuo T, Mitsuoka M, Shirouzu K. Intraoperative intercostal nerve blockade for postthoractomy pain. Ann Thorac Surg 2002; 74: 338–41.

    Article  PubMed  Google Scholar 

  12. Browner WS, Black D, Newman TB, Hulley SB. Estimating sample size and power. In: Hulley, SB, Cummings SR, editors. Designing clinical research: An epidemiological approach. tWilliams and Wilkins, USA, p. 139–51.

  13. Pertunnen K, Nilsson E, Heinonen J, Hirvasalo EL, Salo JA, Kalso E. Extradural, paravertebral and intercostal nerve blocks for post thoracotomy pain. Br J Anaes 1995; 75: 541–47.

    Google Scholar 

  14. Pertunnen K, Kalso E, Heinonen J, Salo JA. I. V. diclofenac in post thoractomy pain. Br J Anaes 1992; 68: 474–80.

    Article  Google Scholar 

  15. Faust RJ, Nauss LA. Post thoractomy intercostal, block: comparison of its effects on pulmonary function and those of intra-muscular meperidine. Anesth Analg 1976; 55: 542–46.

    Article  PubMed  CAS  Google Scholar 

  16. Asantila R, Rosenberg PH, Scheinin B. Comparison of different methods of postoperative analgesia after thoractomy. Acta Anaesth Scand 1986; 30:421–25.

    Article  PubMed  CAS  Google Scholar 

  17. Matthews PJ, Govenden V. Comparison of continuous paravertebral and extradural infusions of bupivicaine for pain relief after thoracotomy. Br J Anaesth 1989; 67: 204–5.

    Article  Google Scholar 

  18. Ozcan PE, Senturk M, Camci E. A comparison of pre-emptive analgesia and postoperative analgesia in thoractomies. Turk Anest Rean Cem Mecmausi 2001, 29: 18–22.

    Google Scholar 

  19. Sentruk M, Ozcan PE, Talu GE, Kiyan E, Camci E, Ozyalcin S, et al. The effects of different analgesia techniques on long term post thoractomy pain. Anesth Analg 2002; 94: 11–15.

    Article  Google Scholar 

  20. Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long term post thoractomy pain. Clin J Pain 1996; 12: 50–55.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, St. John's Medical College Hospital, 560034, Bangalore

    OP Sanjay MD (Associate Professor), P Prashanth DNB & DI Tauro MBBS

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  1. OP Sanjay MD
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  2. P Prashanth DNB
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  3. DI Tauro MBBS
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Correspondence to OP Sanjay MD.

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Sanjay, O., Prashanth, P. & Tauro, D. Intercostal nerve blockade versus thoracic epidural analgesia for post thoracotomy pain relief. Indian J Thorac Cardiovasc Surg 19, 141–144 (2003). https://doi.org/10.1007/s12055-003-0003-6

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  • DOI: https://doi.org/10.1007/s12055-003-0003-6

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