Intrapleural intercostal nerve block associated with mini-thoracotomy improves pain control after major lung resection☆

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Abstract
Objective: To prospectively assess the impact of intrapleural intercostal nerve block (IINB) associated with mini-thoracotomy on postoperative pain and surgical outcome after major lung resections. Methods: Between January 2004 and February 2005, we randomly assigned 120 consecutive patients undergoing mini-thoracotomy (10–13 cm) for major lung resections, to receive or not IINB from the 4th to the 8th space at the moment of thoracotomy using 20 ml (7.5 mg/ml) ropivacain injection at the dose of 4 ml for each space. Postoperative analgesia consisted of continuous intravenous infusion of tramadol (10 mg/h) and ketoralac tromethamine (3 mg/h) for 48 h for all patients. Results: The two groups (60 patients each) were comparable for age, sex, pulmonary function, type and duration of the procedure. Mortality and morbidity were 0% and 10%, respectively, for the IINB group and 3.3% and 15%, respectively, for the non-IINB group (p ≫ 0.05, NS). Mean postoperative pain measured by the ‘Visual Analogue Scale’ were as follows: 2.3 ± 1 at 1 h, 2.2 ± 0.8 at 12 h, 1.8 ± 0.7 at 24 h, and 1.6 ± 0.6 at 48 h for the IINB group; and 3.6 ± 1.4 at 1 h, 3.4 ± 2 at 12 h, 2.9 ± 1.2 at 24 h, and 2.0 ± 1 at 48 h for the non-IINB group. Differences were significant at 1 h, 12 h, 24 h, and 48 h (p ≪ 0.05). Mean postoperative hospital stay was 5.7 days in the IINB group and 6.5 days in the non-IINB group (p ≪ 0.05). Conclusion: IINB associated with mini-thoracotomy reduces postoperative pain and contributes to improve postoperative outcome after major pulmonary resections.

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