The efficacy of intraoperative internal intercostal nerve block during video-assisted thoracic surgery on postoperative pain

Gil Bolotin*, Horia Lazarovici, Gideon Uretzky, Amnon Y. Zlotnick, Ada Tamir, Milton Saute

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Video-assisted thoracic surgery (VATS) is widely used for many thoracic surgical procedures. Postoperative pain is less after VATS than after conventional thoracic surgery, but is still significant. The objective of this study was to assess the efficacy of thoracoscopic, internal intercostal nerve block in alleviating immediate postoperative pain. Methods. Thirty-two patients underwent VATS bilateral sympathectomy for the treatment of hyperhidrosis. The patients were randomly divided into two groups with similar demographic and preoperative physiologic parameters. Group A (n = 16) was submitted to thoracoscopic, internal intercostal nerve blocks performed at T2, T3, and T4 intercostal levels using 3 cc of 0.5% bupivacain in each intercostal space. The injections were performed bilaterally, immediately after the sympathectomy, through the same port. Group B (n = 16) underwent bilateral thoracic sympathectomy without the block. During the immediate postoperative period, heart rate, blood pressure, respiratory rate, pain score, and analgesic requirements were monitored every 30 minutes. Results. No morbidity was recorded in association with the thoracoscopic, internal intercostal nerve block. The mean heart rates (77 ± 6 vs 89 ± 12 beats per minute, p < 0.001), respiratory rates (15 ± 2 vs 18 ± 3 respirations per minute, p < 0.01), pain score (1.9 ± 0.6 vs 2.7 ± 0.5, p < 0.01), and postoperative analgesic requirements (20 ± 18 vs 50 ± 21 mg pethidine HCL, p < 0.001) were significantly lower in group A. There was no significant difference in blood pressures. Conclusions. Thoracoscopic, internal intercostal nerve block with bupivacain 0.5% during VATS is safe and effectively reduced the immediate postoperative pain and analgesic requirements.

Original languageEnglish
Pages (from-to)1872-1875
Number of pages4
JournalAnnals of Thoracic Surgery
Volume70
Issue number6
DOIs
StatePublished - 2000

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