Intercostal nerve block, interpleural analgesia, thoracic epidural block or systemic opioid application for pain relief after thoracotomy?

Abstract

The purpose of this study was to investigate the effect of different pain-relief methods (regional and systemic) following thoracotomies on the cardiovascular system, pulmonary gas exchange, various endocrine parameters and subjective perception. A further aspect was to evaluate the benefits of interpleural analgesia as a new regional technique against already established regional techniques, such as intercostal nerve block and thoracic epidural block. All postoperative pain methods led to a significant time-dependent reduction of the adrenaline concentrations in plasma while the noradrenaline concentrations did not change significantly. There were no statistical differences in catecholamine concentrations among the different study groups, although the mean concentrations of adrenaline in patients having a thoracic epidural block for pain relief were lower in comparison to the findings in other groups. The plasma concentrations of the "stress metabolites", such as glucose, free fatty acids and lactate, as well as the haemodynamic (mean arterial pressure, heart rate) and pulmonary parameters (blood gas analyses), showed no significant differences among groups. In contrast to the other pain-relieving methods, interpleural analgesia did not lead to sufficient pain relief in that 7 out of 10 patients needed supplementary systemic opioid therapy. Therefore, interpleural analgesia for pain relief following thoracotomies cannot be recommended.

Subpleural block is less effective than thoracic epidural analgesia for post-thoracotomy pain

“…7,8,10,11 Bachmann-Mennenga et al, 10 Von Dossow et al 11 and Davies et al 7 showed that VAS at rest in the presence of thoracic epidural ranged between 1 and 6 cm which is comparable with the range of VAS R in the current study. Furthermore, in a recent meta-analysis, Davies et al 7 showed that the incidence of hypotension was 19% during TEA which is comparable with the 24% incidence of hypotension reported in the current study.…”

Post-thoracotomy analgesia

“…[ 4 ] The lack of benefit has been shown in multiple studies and this technique is not recommended for post-thoracotomy pain. [ 4 60 61 62 ]…”

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

“…While there are reports which address safety and advantages of intrapleural block in postthoracotomy patients [43–50], most other studies showed little or no benefit for ISP [11, 51–55]. As an interesting finding, intrapleural block could not decrease epidural analgesia requirement and have little effect on intercostal incisional pain after thoracotomy, too [11, 57].…”