Postoperative pain control with continuous paravertebral nerve block and intercostal nerve block after two-port video-assisted thoracic surgery

Abstract

Introduction: Effective pain control after video-assisted thoracic surgery (VATS) is critical because of the correlation between postoperative pain and recovery after surgery. Due to the limitations of traditional analgesic modalities, in this study, we present a method of placing a paravertebral catheter (PVC) or an intercostal catheter (ICC) in the sub-pleural space, followed by continuous ropivacaine injection by an infusion pump after surgery.

Aim: To investigate the impact of continuous paravertebral nerve block and intercostal nerve block on postoperative pain control in patients who underwent two-port thoracic surgery.

Material and methods: A total of 269 patients underwent various types of two-port VATS at Hwa Mei Hospital. Among them, we retrospectively compared paravertebral block versus intercostal nerve block to intravenous patient-controlled analgesia after VATS. Data regarding postoperative pain score on postoperative day 0, 1, 2, 3, and discharge day pain score, tramadol requirements, drainage duration, postoperative hospital stay, postoperative complications, and chronic pain 3 months after surgery were collected and analyzed.

Results: Compared with the control group, patients who received a continuous nerve block, including the PVC group and ICC group, had a lower postoperative pain score (p < 0.001), shorter drainage duration (4.63 ±2.84 to 5.61 ±2.66 days, p = 0.004), reduced postoperative hospital stay (6.04 ±3.01 to 7.69 ±3.26 days, p < 0.001), and a reduced frequency of tramadol (0.95 ±1.27 1.79 ±2.13 times, p < 0.001). Additionally, there was no significant difference in chronic pain between groups.

Conclusions: In our study, PVC and ICC appeared to be safe and effective analgesic techniques to reduce postoperative pain, thus shortening the duration of postoperative hospital stay and improving the satisfaction of patients.

Keywords: Enhanced Recovery After Surgery program; intercostal nerve block; minimally invasive surgery; paravertebral nerve block; postoperative analgesia; video-assisted thoracic surgery.

Photo 1

A – Placement of PVC by thoracoscopic guidance. The red arrow indicates the PVC. B – Placement of ICC by thoracoscopic guidance. The red arrow indicates the ICC. C – The electrical infusion pump (Apon) and catheter (Specath) PVC – paravertebral catheter, ICC – intercostal catheter.

Figure 1

Postoperative pain control. A – Compared with the control group, patients in the PVC group and ICC group obtained a lower pain score on postoperative day 0, 1, 2, 3 and discharge day. There was no significant difference in postoperative day 0, 1, 2, 3 and discharge day between the PVC group and the ICC group. B – Dosage of tramadol after surgery in the control group, the PVC group and the ICC group. C – Drainage duration and postoperative hospital stay in the control group, the PVC group and the ICC group. D – Compared with the control group, more patients in the PVC group and ICC group had no complaints about long-term postoperative pain, and fewer patients in the PVC group and ICC group suffered from moderate and severe pain (NRS ≥ 4) PVC – paravertebral catheter, ICC – intercostal catheter, NRS – numerical rating scale.

Figure 2

Postoperative complications in the control group, the PVC group and the ICC group PVC – paravertebral catheter, ICC – intercostal catheter.