Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Abstract

Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) affects patients’ recovery, postoperative complications, and length of stay (LOS). Despite its relevance, there are no guidelines on optimal perioperative pain management. This study aims to analyse the effects of an additional intercostal catheter (ICC) in comparison to a single shot intraoperative intercostal nerve block (SSINB). Methods: All patients receiving an anatomic VATS resection between June 2019 and May 2020 were analysed retrospectively. The ICC cohort included 51 patients, the SSINB cohort included 44 patients. Results: There was no difference in age, gender, comorbidities, or duration of surgery between cohorts. Pain scores on the first postoperative day, after chest drain removal, and highest pain score measured did not differ between groups. The overall amount of opioids (morphine equivalent: 3.034 mg vs. 7.727 mg; p = 0.002) as well as the duration of opioid usage (0.59 days vs. 1.25 days; p = 0.005) was significantly less in the ICC cohort. There was no difference in chest drain duration, postoperative complications, and postoperative LOS. Conclusions: Pain management with ICC reduces the amount of opioids and number of days with opioids patients require to achieve sufficient analgesia. In conclusion, ICC is an effective regional anaesthesia tool in postoperative pain management in minimally invasive thoracic surgery.

Efficacy of preemptive intercostal nerve block on recovery in patients undergoing video-assisted thoracic lobectomy

“…In this observation, pre-ICNB resulted in rapid rehabilitation with faster extubation in PACU, due to much less use of intraoperative analgesic drugs. Pre-ICNB implemented before operation can decrease the dosage of intraoperative opioid drugs by 22% in this study, which resulted in the same result as Ponholzer’s [ 20 ]. It is no doubt that the reduction of intraoperative analgesics is more helpful to stabilize hemodynamics in severe or elderly patients [ 21 ], mitigating the risk of postoperative pneumonia and atelectasis in thoracic patients, and decreasing the incidence of needing intensive care unit [ 22 , 23 ].…”

“…Preemptive ICNB is proven to provide equivalent pain relief to TEB during operation [ 26 ]. However, the ICNB is often accepted by surgeons to block after the operation considering the pharmacodynamics of local anesthetics [ 3 , 20 ]. Lidocaine and ropivacaine are commonly applied to intercostal nerve block owing to their simplicity and low cost.…”

“…The intercostal catheter may be the latest and most effective postoperative analgesia. However, it is still worried about catheter infections, and poor analgesia caused by catheter displacement, and it needs certain practice to successfully implement this method [ 20 ]. ICNB is convenient for thoracic surgeons to perform without a learning curve and no need for ultrasound.…”

Analysis of Pain Management after Anatomic VATS Resection in Austrian Thoracic Surgery Units

“…ICCs represent such an alternative, as they use the same equipment as an EA, are easy to perform and are a feasible option to reduce opioid usage [ 14 ]. Moreover, ICCs do not add significant delay to operating time, which might further improve its acceptance as an addition to already-available pain management systems [ 15 ]. As pain after VATS resections seems to originate from the area of the chest drain and is in decline after chest drain removal, ICCs provide a feasible option to overcome this initially painful phase by locally targeting the affected intercostal space [ 15 , 16 ].…”

Stripping Massage and Literature Review in Post-Thoracoscopic Chest Pain Management

“…• Intercostal catheter ropivacaine 39 > single shot intercostal nerve block or preoperative ropivacaine at incision wound Reducing in-hospital narcotic consumption.…”