Effect of Intercostal Nerve Blockade During Operation on Lung Function and the Relief of Pain Following Thoracotomy

Galway, J. E.; Caves, Philip K.; Dundee, J. W.

doi:10.1093/bja/47.6.730

Cited by 50 publications

(25 citation statements)

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“…on pain and ventilation have been reported in other studies. Most authors have found the method very satisfactory (20,21,26,40), but a few have reported little advantage over treatment with centrally acting analgesics (42,43). These discrepancies might, as in the present study, be due to differences in the type of incision and surgery, and to whether a uni-or bilateral block has been applied, but might also be explained by differences in the site of blocking of the intercostal nerves.…”

Section: Fevr/fvc (Yo)mentioning

confidence: 46%

Respiratory Performance After Upper Abdominal Surgery. A Comparison of Pain Relief with Intercostal Blocks and Centrally Acting Analgesics

Engberg¹

1986

Survey of Anesthesiology

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The respiratory capacity was studied during the first 2 days postoperatively in 94 patients, aged 19 tn 75 years and undergoing surgery through an upper abdominal incision. Postoperative pain relief was randomly administered, either by intercostal block (i.c.b.) and centrally acting analgesics on demand, or by centrally acting analgesics alone. Respiratory studies comprising forced vital capacity (FVC), forced expiratory volume in one second (FEVI), peak expiratory flow rate (PEF) and analysis of arterial blood gases were madc. Bilateral i.c.b. given after surgery performed through a midline incision did not improve the respiratory function, whereas unilateral i.c.b. after surgery through a subcostal incision had positive effects. Thus postoperative i.c.b. following cholecystectomy performed through a subcostal incision resulted in higher FVC, FEV, and PEF values than without i.c.b. at least during the time of effective nerve block. 1.c.b. after subcostal incision also improved arterial oxygen tension. The patients undergoing cholecystectomy and receiving a second i.c.b. 8 h after the first one had better respiratory function than the patients without any block during the first 2 days postoperatively.

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Section: Fevr/fvc (Yo)mentioning

confidence: 46%

Respiratory Performance After Upper Abdominal Surgery. A Comparison of Pain Relief with Intercostal Blocks and Centrally Acting Analgesics

Engberg¹

1986

Survey of Anesthesiology

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“…Delilkan and others (1973) and Faust and Nauss (1976) showed that intercostal block gave better analgesia and caused less hypercarbia than did opiate analgesia. Conversely, Galway, Caves and Dundee (1975) found that intercostal block was ineffective, and that there was no difference in Pa^ values between patients receiving intercostal block and controls. Presumably, this is because both groups of patients received opiates, whereas probably only the control group had received opiates at the time that •Pa C02 values were measured in the former studies.…”

Section: Discussionmentioning

confidence: 88%

“…Retention of carbon dioxide is more severe in patients with spirometric evidence of emphysema (Swenson, StallbergStenhagen and Beck, 1961) and is possibly more severe if lung tissue is resected (Pandit, Galway and Dundee, 1973). Patients recovering from thoracotomy are more sensitive to the respiratory depressant effects of opiates than are patients recovering from upper abdominal surgery (Galway, 1972). Delilkan and others (1973) and Faust and Nauss (1976) showed that intercostal block gave better analgesia and caused less hypercarbia than did opiate analgesia.…”

Section: Discussionmentioning

confidence: 99%

Oxygen Therapy After Thoracotomy

Drummond¹,

Milne²

1977

British Journal of Anaesthesia

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SUMMARYArterial blood samples were taken from patients before thoracotomy, and on the 1st day after operation, with the patient breathing first air, and then 24%, 28% and 35% oxygen from a venturitype mask. Pao t was reduced markedly by operation, the reduction being related to the value before operation. Oxygen therapy restored P&o t to a value greater than the value before operation in nine of 11 patients and was not associated with significant increases in Paco,. The effect of administration of oxygen on Pao, could be predicted from the Pao t when breathing air. The pattern of response to oxygen suggested that the hypoxaemia was caused by ventilation/perfusion mismatch in most of the patients.Lung function is impaired severely after thoracotomy; arterial oxygen tension is reduced, and carbon dioxide tension may be increased, particularly within hours of the operation (Maier and Cournand, 1943; Bjork and Hilty, 1954;Hood and Beall, 1958;Knudsen, 1970). Opiate analgesia may increase the respiratory acidosis (Pandit, Galway and Dundee, 1973).Patients studied on the day after thoracotomy have persistent hypoxaemia, but reduced .Pa COl! values (Hatch, 1966;Bergh et al., 1966). In this respect, they resemble patients recovering from upper abdominal surgery, whose gas exchange is impaired by ventilation/perfusion (l?y$) mismatch rather than respiratory depression. Nevertheless, it is possible that, after thoracotomy, patients remain susceptible to respiratory depression, and that this is masked by the stimulus of hypoxaemia. The influence of controlled oxygen therapy on arterial oxygen and carbon dioxide tensions in such patients has not been reported.This study was designed to assess the effects of oxygen therapy after thoracotomy. The response of Pa Oa to different oxygen fractions (Fi Oi ) might indicate the mechanism of impairment of gas transfer (Kerr, 1975; Drummond and Wright, 1977). The difference between the calculated oxygen content of blood leaving the pulmonary capillaries (Cc'o 2 ) and the oxygen content of arterial blood (Ca Oj ) can be used as an index of impaired gas transfer, in the same way as the difference between alveolar and arterial oxygen tensions (PA 02 -Pa 02 ) has been used. The advantage of the former expression is that it is not changed by changes in alveolar oxygen tension if the impaired oxygenation is caused by the shunting of a constant fraction of blood through regions where it is not exposed to gas exchange. A reduction in the value of the index during administration of oxygen shows that increasing the alveolar oxygen tension improves the efficiency of oxygen transfer, which is characteristic of impaired exchange caused by fjQ mismatch (West, 1969). This analysis depends upon the assumption that the oxygen content difference between arterial and mixed venous blood (Ca 02 -Cv 02 ) is not changed by oxygen administration.If oxygen therapy were associated with an increase in PacQj,, this would suggest that respiration had been stimulated by hypoxia when the patient was breathing ai...

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“…By this way, spinal nerves from T1 through T 11 can be blocked effectively decreasing VAS pain scores significantly. Local anesthetics can be infused as a single dose just before closure of the thoracotomy (11,(33)(34)(35)(36), as a single (37) or multiple (38) percutaneous injections or via an indwelling intercostal catheter (39)(40)(41). Intercostal blockade can reduce opioid requirements, however, cannot eliminate them.…”

Section: Intercostal Blockadementioning

confidence: 99%

Postoperative pain management

1998

Acta Anaesthesiol Scand

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Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesiarelated complications or side effects.

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Effect of Intercostal Nerve Blockade During Operation on Lung Function and the Relief of Pain Following Thoracotomy

Cited by 50 publications

References 0 publications

Respiratory Performance After Upper Abdominal Surgery. A Comparison of Pain Relief with Intercostal Blocks and Centrally Acting Analgesics

Respiratory Performance After Upper Abdominal Surgery. A Comparison of Pain Relief with Intercostal Blocks and Centrally Acting Analgesics

Oxygen Therapy After Thoracotomy

Postoperative pain management

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