BACKGROUND: Thoracic epidural analgesia is considered the method of choice for postthoracotomy analgesia, but it is not suitable for every patient and is associated with some risks and side effects. We therefore evaluated the effects of an extrapleural intercostal analgesia as an alternative to thoracic epidural analgesia. METHODS: In a prospective, randomized study, pain control, recovery of ventilatory function, and pulmonary complications were analyzed in patients undergoing elective lobectomy or bilobectomy. Two groups of 15 patients each were compared: one received acontinuous extrapleural intercostal nerve blockade (T3 through T6) with bupivacaine through an indwelling catheter, the other was administered a combination of local anesthetics (bupivacaine) and opioid analgesics (fentanyl) through a thoracic epidural catheter. RESULTS: Both techniques were safe and highly effective in terms of pain relief and recovery of postoperative pulmonary function. However, minor differences were observed that, together with practical benefits, would favor extrapleural intercostal analgesia. CONCLUSIONS: These results led us to suggest that extrapleural intercostal analgesia might be a valuable alternative to thoracic epidural analgesia for pain control after thoracotomy and should particularly be considered in patients who do not qualify for thoracic epidural analgesia.
RCT Entities:
BACKGROUND: Thoracic epidural analgesia is considered the method of choice for postthoracotomy analgesia, but it is not suitable for every patient and is associated with some risks and side effects. We therefore evaluated the effects of an extrapleural intercostal analgesia as an alternative to thoracic epidural analgesia. METHODS: In a prospective, randomized study, pain control, recovery of ventilatory function, and pulmonary complications were analyzed in patients undergoing elective lobectomy or bilobectomy. Two groups of 15 patients each were compared: one received a continuous extrapleural intercostal nerve blockade (T3 through T6) with bupivacaine through an indwelling catheter, the other was administered a combination of local anesthetics (bupivacaine) and opioid analgesics (fentanyl) through a thoracic epidural catheter. RESULTS: Both techniques were safe and highly effective in terms of pain relief and recovery of postoperative pulmonary function. However, minor differences were observed that, together with practical benefits, would favor extrapleural intercostal analgesia. CONCLUSIONS: These results led us to suggest that extrapleural intercostal analgesia might be a valuable alternative to thoracic epidural analgesia for pain control after thoracotomy and should particularly be considered in patients who do not qualify for thoracic epidural analgesia.
Authors: V Mann; S Mann; A Hecker; R Röhrig; M Müller; T Schwandner; M Hirschburger; A Sprengel; M A Weigand; W Padberg Journal: Chirurg Date: 2011-10 Impact factor: 0.955
Authors: Raul Ribeiro de Andrade; Natália de Oliveira Lima; Marina Viegas Moura Rezende Ribeiro; Fernando Wagner da Silva Ramos; Célio Fernando de Sousa-Rodrigues; Fabiano Timbó Barbosa Journal: Rev Assoc Med Bras (1992) Date: 2022-08 Impact factor: 1.712
Authors: Mark S Allen; Lisa Halgren; Francis C Nichols; Stephen D Cassivi; William S Harmsen; Dennis A Wigle; K Robert Shen; Claude Deschamps Journal: Ann Thorac Surg Date: 2009-09 Impact factor: 4.330
Authors: Paul Karanicolas; Sean Cleary; Paul McHardy; Stuart McCluskey; Jason Sawyer; Salima Ladak; Calvin Law; Alice Wei; Natalie Coburn; Raynauld Ko; Joel Katz; Alex Kiss; James Khan; Srinivas Coimbatore; Jenny Lam-McCulloch; Hance Clarke Journal: Trials Date: 2014-06-21 Impact factor: 2.279