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Observational Study
. 2021 Jul 31;16(1):210.
doi: 10.1186/s13019-021-01590-z.

Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Jian Wei Tan  1 , Jameelah Sheik Mohamed  2 , John Kit Chung Tam  3   4
Affiliations
Observational Study

Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Jian Wei Tan et al. J Cardiothorac Surg. .

Abstract

Background: Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS.

Methods: In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay.

Results: No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0-2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1-2). Mean post-operative length of stay was 4.17 ± 2.50 days.

Conclusions: Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

Keywords: Intercostal catheter; ON-Q pain relief system; Postoperative recovery after thoracic surgery; Subpleural analgesia; Uniportal video-assisted thoracoscopic surgery (UVATS).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of patients who were prescribed morphine patient-controlled analgesia by the acute pain team
Fig. 2
Fig. 2
Percentage of patients who required non-opioid rescue analgesics only
Fig. 3
Fig. 3
Percentage of patients who did not require rescue analgesics
See this image and copyright information in PMC

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References

    1. Elmore B, Nguyen V, Blank R, Yount Y, Lau C. Pain management following thoracic surgery. Thorac Surg Clin. 2015;25:393–409. - PubMed
    1. Yeap YL, Wolfe JW, Backfish-White KM, Young JV, Stewart J, Ceppa DP, et al. Randomized prospective study evaluating single-injection paravertebral block, paravertebral catheter, and thoracic epidural catheter for postoperative regional analgesia after video-assisted thoracoscopic surgery. J Cardiothorac Vasc Anesth. 2020;34:1870–1876. - PubMed
    1. Piccioni F, Ragazzi R. Anaesthesia and analgesia: how does the role of anesthetists changes in the ERAS program for VATS lobectomy. J Vis Surg. 2018;4:9. - PMC - PubMed
    1. Kosinski S, Fryzlewicz E, Wilkojc M, Cmiel A, Zielinski M. Comparison of continuous epidural block and continuous paravertebral block in postoperative analgesia after video-assisted thoracoscopic surgery lobectomy: a randomised, non-inferiority trial. Anaesthesiol Intensive Ther. 2016;48:280–287. - PubMed
    1. Okajima H, Tanaka O, Ushio M, Higushi Y, Nagai Y, Iijima K, et al. Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery. J Anesth. 2015;29:373–378. - PubMed

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