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Abstracts and Programme, EUROANAESTHESIA 2008: Local and Regional Anaesthesia

Analgesia after thoracotomy: Is an intercostal nerve block plus intravenous patient-controlled analgesia with morphine as effective as patient-controlled epidural anaesthesia with sufentanil/ropivacaine? A prospective randomized clinical study

8AP4-9

Gorsewski, G.; Hock, D.; Eva, B.; Stefan, K.; Rainer, M.

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European Journal of Anaesthesiology (EJA): May-June 2008 - Volume 25 - Issue - p 116
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Background and Goal of Study: Epidural anaesthesia (EDA) is considered by many to be the best method of pain relief after thoracic surgery (1). An intraoperatively performed intercostal nerve block (ICB) plus intravenous patient controlled analgesia (PCA) with opioids could be an easier, less time consuming and safer alternative to EDA, but data about the efficacy of this technique are scarce. Thus the main objective of the present study was to evaluate the analgetic efficacy of the ICB in comparison to EDA in patients undergoing pulmonary surgery through a posterolateral thoracotomy.

Materials and Methods: With approval of the local ethic committee 55 patients were randomly allocated to the EDA-Group (n=27) or ICB-Group (n=28). Patients in the ICB-Group received intraoperatively a 5 segment intercostal block with 30 ml ropivacaine 0.75% and postoperatively intravenous PCA morphine. Patients in the EDA Group received intraoperatively ropivacaine 1% through a thoracic epidural catheter (TH6-TH8) and postoperatively patient controlled EDA with ropivacaine 0.2% and sufentanil 2μg/ml. Using the numeric rating scale (NRS: 0-10) pain was assessed at rest and during coughing 1h after arrival in the recovery room (1h PO) and at the first four postoperative days (POD).

Results and Discussion: The median NRS values are shown in the table. Apart from the NRS values obtained in the recovery room there was a tendency to higher NRS values in the ICB-Group at rest as well as during coughing. At the second POD the difference was significant during coughing (*p<0.01).

Table
Table:
Postoperative NRS pain scores at rest and during coughing expressed as medians

Conclusion(s): We conclude that in particular during coughing ICB with subsequent IV PCA does not achieve the same analgetic efficacy as patient controlled EDA. This might be important with respect to possible postoperative pulmonary complications.

References:

Gottschalk A. et al. Preventing and treating pain after thoracic surgery. Anesthesiology 2006; 104: 594-600.
© 2008 European Society of Anaesthesiology