Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection

Abstract

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.

Keywords: Single port VATS; anatomic resection; intercostal nerve block.

Figure 1

Flowchart of the study enrollment. VATS, video-assisted thoracoscopic surgery.

Figure 2

ICC was placed in the sub-pleural space, which was the same intercostal space of wound. ICC, intercostal catheter.

Figure 3

Injection levobupivacaine before and after ICC was inserted through subpleural space. (A) Before and (B) after 10 mL levobupivacaine (0.5%) was injected through the catheter into the sub-pleural space. ICC, intercostal catheter.

Figure 4

With the help of continuous intercostal nerve block, patients could easily ambulate in the ward on postoperative day 1.

Figure 5

Patients with ICC had less pain, less postoperative analgesia drug demand, better triflow performance, shorter drainage duration and hospitalization compared with patients without ICC. (A) Pain score for patients who received continuous intercostal nerve block (ICC) or single shot intercostal nerve analgesia (No ICC) on postoperative day 0, 1, 2, 3, discharge day (P=0.023, 0.001, 0.481, 0.594, 0.531); (B) triflow rehabilitation performance for patients who received continuous intercostal block or single shot intercostal nerve analgesia (no ICC) on pre op, day 1, 2, 3, discharge day (P=0.175, 0.015, 0.032, 0.815, 0.864); (C) postoperative IV form morphine demand, chest tube drainage duration, hospital stay on ICC and no ICC group (P=0.017, 0.001, 0.005). ICC, intercostal catheter.

Figure 6

Bleeding control of segmental artery (A6) by single port surgery (25). Available online: http://www.asvide.com/articles/1304