Postoperative Analgesia for Thoracotomy Patients

Abstract

Severe postoperative pain, which may persist for up to 3 days and may lead to postoperative complications, due to the patient's inability to breathe deeply and cough, is frequently experienced in the area of the incision and chest tubes by thoracotomy patients. Eighteen patients undergoing routine thoracotomies were tested preoperatively for arterial blood gases and pulmonary function and given chest x-rays. Anesthesia consisted of thiopental, succinylcholine, N2O, enflurane, and pancuronium. Before incision closure, 6 intercostal spaces were injected by the surgeon with 3 ml of a randomly determined drug mixture. Patients received either bupivacaine and saline solution, bupivacaine and LMW dextran 40, or saline and LMW dextran 40. Arterial blood gases, pulmonary function, chest x-rays, narcotic dosage, sensory level, and subjective responses were evaluated for 3 days postoperatively. Results demonstrate that intercostal nerve blocks can markedly reduce postoperative pain and improve pulmonary function in such patients. Significant differences from controls were seen in Pao2, Paco2, vital capacity, forced expiratory flow rates, analgesic requirements, and patient comfort. The duration of the block with bupivacaine and saline was less than 12 hours, while the mean duration of the block with bupivacaine and dextran 40 was 36 hours.

Levobupivacaine – dextran mixture for transversus abdominis plane block and rectus sheath block in patients undergoing laparoscopic colectomy: a randomised controlled trial

“…We also found that the addition of dextran to levobupivacaine provided better analgesia throughout the first postoperative day. The analgesic potentiating effects of dextran added to local anaesthetics are well known for infiltration anaesthesia, as well as nerve blocks and epidural anaesthesia . The present results are consistent with previous studies.…”

“…We previously found that the addition of low‐molecular weight dextran to a local anaesthetic mixture with adrenaline reduced the absorption of adrenaline into the bloodstream . Furthermore, addition of various types of dextran, irrespective of the presence of adrenaline, has been found to prolong the effectiveness of local anaesthetics . Because of this, we speculated that addition of dextran to the local anaesthetic would reduce the increase in plasma concentration after combined single‐shot TAP and rectus sheath blocks in patients undergoing laparoscopic colectomy.…”

Analgesia and pulmonary function after lung surgery: is a single intercostal nerve block plus patient-controlled intravenous morphine as effective as patient-controlled epidural anaesthesia? A randomized non-inferiority clinical trial

“…This finding is in agreement with other studies that have investigated the effects of a single intercostal nerve block. 11 13 15 25 In contrast to ICB, there is some evidence that a before operation paravertebral block may produce longer-acting analgesic effects due to a pre-emptive analgesic effect. This potential of paravertebral block has been described in the context of breast surgery 26 27 and thoracic surgery 28 29 and it has been speculated that one reason for this effect of paravertebral block might be that, in contrast to the ICB, it completely blocks transmission within the sympathetic chain.…”

The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled analgesia

“…Continuous injection of local analgesia into the surgical incision site has been effectively used to reduce the side effects of narcotics [1-16]. The ON-Q pain management system (ON-Q PainBuster, referred to as ON-Q pump) created by the I Flow Corp. (Lake Forest, CA, USA) is a device that continuously administers local analgesia directly into the intra-abdominal surgical wound site.…”