Experience of Continuous Intercostal Nerve Block for Management of the Post thoracotomy Pain: 10 cases

Won, Kyung Sub; Lee, Jeong Seok; Kim, Yong Ik; Hwang, Kyung Ho; Park, Wook

Abstract

Intercostal nerve blockade with local anesthetics has been used extensively in the past to provide pain relief following thoracotomy. Its popularity fell, for a period, probably due to increasing use of epidural analgesia. More recently, interest has focused on intercostal nerve block with the introduction of variously sited catheters. Two epidural catheters were placed under direct vision, in the intercostal spaces just above and below the wound by feeding the catheters posteriorly from the wound edges, superficial to the parietal pleura. Bupivacaine 0.25%, was infused continuously at a rate of 5 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml of 0.25% bupivacaine. Postoperative vital signs resembled preoperation data. Arterial carbon dioxide pressure (PaCO2) was unchanged and arterial oxygen pressure (PaCO2) was increased during two days after surgery because oxygen was administered at 21/min. Forced vital capacities (FVC) and forced expiratory volume in 1 second (FEV1) were decreased the day of operation but restored to preoperative value from second operation day. VAS were increased on operation day but decreased from second operation day. Motion range of arms were not impaired. We concluded that continuous intercostal nerve block through catheters placed during thoracotomy in the adjacent intercostal spaces is a simple and effective method for management of the post-thoracotomy pain.