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Post-Thoracotomy Pain and Pulmonary Function - Comparison of Intermittent Intercostal Bupivacaine Vs Intravenous Pethidine Pubmed



Ghafouri A1 ; Movafegh A2 ; Nasresfahani M1 ; Gholamrezanezhad A3, 5 ; Madhkhan S4
Authors
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Authors Affiliations
  1. 1. Department of General and Thoracic Surgery, Shariati Teaching Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Anesthesia and Critical Care, Shariati Teaching Hospital, Faculty of Medicine, Tehran, Iran
  3. 3. Shariati Hospital, Tehran, North Karegar St., Iran
  4. 4. Department of General Surgery, Faculty of Medicine, Isfahan University of Medical Sciences, Tehran, Iran
  5. 5. Shariati Hospital, Medical Sciences, Tehran University, 14114, Tehran, Iran

Source: Middle East Journal of Anesthesiology Published:2008


Abstract

Objective and Methods: In a prospective, observer-blind study, 50 patients scheduled for posterolateral thoracotomy were investigated to compare the effects of intermittent intercostal extrapleural bupivacaine (n = 25) and intravenous pethidine (n = 25) on post-thoracotomy pain and pulmonary function. The severity of chest pain (objectified by the use 5-point scale of Prince Henry) and changes in spirometric values [forced vital capacity (FVC), forced expired volume in 1 s (FEV1) and FEV1/FVC] were monitored during the first three postoperative days.Because intravenous pethidine was used to supplement pain relief in the patients who received intercostal analgesia, total pethidine used was compared to that administered to patients in the intravenous pethidine group. Results: There were no statistical significant differences regarding patient demographics in both groups. No complications occurred. There was no significant difference between mean pain scores in the first postoperative day, bur in the second and third postoperative days and also in the whole first 72 post-operative hours, pain scores were significantly higher in the intravenous group than the intercostal group. The post-operative decrease in FVC and FEV1 was significantly less with intercostal bupivacaine compared with the intravenous pethidine. There was no significant intergroup difference in the post-to pre-operative FEV1/FVC ratio. The total amount of the pethidine received by the patients was significantly higher in the intravenous group than the intercostal group. Conclusion: Intermittent intercostal nerve block with bupivacaine appears to be a promising, safe and reliable technique in the management of post-thoracotomy pain. Use of intercostal bupivacaine could significantly reduce or even eliminate the postoperative need for systemic narcotics.
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