J Korean Pain Soc.  2002 Dec;15(2):132-138.

Effects of Intercostal Nerve Block Combined with IV-PCA on Postoperative Analgesia and Pulmonary Function Recovery after Thoracotomy

• Kwon MI
• Kim KS
• Shin OY
• Oh JY

Abstract

BACKGROUND: This study evaluated the effects of an intercostal nerve block combined with intravenous patient-controlled analgesia (PCA) on pain and pulmonary function recovery after a thoracotomy.
METHODS
45 patients planning to undergo an elective thoracotomy were selected and randomly located into one of 3 groups. The groups were divided into ICB, PCA and ICB-PCA groups. ICB was performed by injecting 2 ml of 0.5% bupivacaine into each of upper and lower two segments including the intercostal spaces of the surgical incision site. The patients receiving PCA were administered a IV bolus of ketorolac 0.5 mg/kg, followed by PCA with fentanyl 1,000micro gram, ketorolac 300 mg, ondansetron 8 mg mixed in 100 ml of normal saline (basal rate 1.0 ml/hr, bolus dose 1.0 ml, and lockout interval time 15 minutes). In each group, the inspiratory capacity and PaCO2 were checked preoperatively and postoperativly at 6, 24, 48 hours for ICB, PCA and ICB-PCA groups, VAS score was checked for three group and cumulative dose of used PCA analgesics was confirmed at 6, 24, 48 hours for the PCA and ICB-PCA groups, postoperatively.
RESULTS
The inspiratory capacity showed a smaller decrease in the PCA (P<0.05) and ICB-PCA group (P<0.01) than the ICB group at 6 and 24 hours. At 48 hours there were no difference between the ICB and PCA groups, but the ICB-PCA group recovered faster than the ICB group (P<0.05). The PaCO2 of the PCA and ICB-PCA groups were found to recover faster to the preoperative range than the ICB group. The analgesic effects of the ICB-PCA group was better than either the PCA or ICB groups (P<0.05).
CONCLUSIONS
Intercostal nerve blocks added to PCA has a benefit on the recovery of the postoperative pulmonary function and also provide superior analgesia after a thoracotomy when compared to PCA or ICB alone. The Authors recommend a combination of an intercostal block with IV-PCA for patients undergoing a thoracotomy due to better postoperative analgesia and faster recovery of pulmonary function.

Keyword

Inspiratory capacity; Intercostal nerve block; Intravenous patient controlled analgesia; Thoracotomy

MeSH Terms

Analgesia*
Analgesia, Patient-Controlled
Analgesics
Bupivacaine
Fentanyl
Humans
Inspiratory Capacity
Intercostal Nerves*
Ketorolac
Ondansetron
Passive Cutaneous Anaphylaxis
Recovery of Function*
Thoracotomy*
Analgesics
Bupivacaine
Fentanyl
Ketorolac
Ondansetron