ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The effect of intercostal nerve block on epidural analgesia in patients undergoing thoracotomy
Aşina Pınar1, Hasan Hepağuşlar1, Ulaş Pınar1, Ahmet Önen2, Aydın Şanlı2, Volkan Karaçam2, Ünal Açıkel2, Zahide Elar1
1Dokuz Eylül Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İzmir
2Dokuz Eylül Üniversitesi Tıp Fakültesi, Göğüs Cerrahisi Anabilim Dalı, İzmir
DOI : 10.5606/tgkdc.dergisi.2012.015
Background: In this study, we investigated the effect of intraoperative multiple-segment intercostal nerve block (INB) on postoperative epidural morphine consumption and analgesia quality in the patients undergoing thoracotomy.

Methods: Following ethics committee approval, 60 patients (Class ASA I-III, age of 18-65 years) who were scheduled to undergo elective thoracotomy were randomly assigned into two subgroups equally, including epidural analgesia (EA) group and epidural plus intercostal analgesia (EIA) group. Prior to closure of the thoracotomy incision, 10 mL of 0.9% NaCl was administered to the surgical incision site, beginning from two upper segments to two lower segments in the EA group. Ten mL of 0.5% bupivacaine was also administered to the same incision site in the EIA group. Postoperative analgesia was maintained with epidural morphine (0.1 mg/mL) via patient-controlled analgesia device (bolus dose: 0.5 mg, lock out time: 30 min). Pain scores of the patients and morphine consumption were recorded within the first four hours (hourly) and then at 12, 24, 48 and 72 hours following surgery.

Results: Excluding gender distribution (the number of female patients in the EIA group >EA group, p<0.05), there is no significant difference between the groups in respect of the baseline demographic and clinical characteristics (p>0.05). Static pain scores (at 0, 1, 2, 3, 4, 12, 48 and 72 hours, p<0.05), dynamic pain scores (at 0, 1, 2, 3, 4, 24, 48 and 72 hours, p<0.05) and postoperative epidural morphine consumption (at 24 hours [EA group: 145±52 μg/kg, EIA group: 117±53 μg/kg, p<0.05], at 48 hours [EA group: 218±81 μg/kg, EIA group: 164±91 μg/kg, p<0.05] and at 72 hours [ EA group: 267±104 μg/kg, EIA group: 188±101 μg/kg, p<0.05]) were significantly lower in the EIA group.

Conclusion: We concluded that intraoperative INB in combination with postoperative epidural morphine consumption for pain control in the patients undergoing thoracotomy may be more effective, compared to postoperative epidural consumption alone.

Keywords : Epidural analgesia; intercostal nerve block; thoracotomy
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