Effect of Intercostal Block on Lung Function After Thoracotomy

Np, Bergh; Dottori, O.; Ba, Löf; Simonsson, Bengt; Ygge, Hans

doi:10.1111/j.1399-6576.1966.tb01107.x

Cited by 25 publications

(25 citation statements)

References 8 publications

(1 reference statement)

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“…We were surprised to find no difference in the degree of impairment of vital capacity and peak expiratory flow rate after operation between groups of patients who had or had not removal of lung tissue. The decrease in VC and PEFR was very similar to that found by other investigators (Bergh et al, 1966;Jorgensen, 1967;Tammisto and Sivula, 1967;Delilkan et al, 1973) in similar conditions. However, the present work did not show the improvement from the use of local anaesthetic agents reported by Dottori and colleagues (1964), Bergh and colleagues (1966) and Delilkan and others (1973).…”

Section: Discussionsupporting

confidence: 91%

“…Other workers have studied various facets of pain relief, such as analgesic requirements after operation (Graham, Seldon and Priestley, 1949), the rate of return of cutaneous sensation around the wound (Telivuo, 1963(Telivuo, , 1964, changes in lung function tests (Bergh et al, 1966) and the patient's subjective assessment of the pain (Jorgensen, 1967), or a combination of more than one of these features (Masson, 1962). In some published trials numbers were limited while in others a double-blind technique was not employed.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy

Galway¹,

Caves²,

Dundee³

1976

Pain

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy

Galway¹,

Caves²,

Dundee³

1976

Pain

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“…The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded (5 were not written in the English language, 4 included interventions that were mislabeled as ICNB, 3 did not include a group of patients who received ICNB with local anesthesia, 3 were systematic reviews, 2 were editorials or short reports, 1 examined outcomes outside the scope of the present study, 1 had insufficient reporting, and 1 examined nonthoracic surgery). All of the remaining 66 studies 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ,…”

Section: Resultsmentioning

confidence: 99%

“…Among 66 studies 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

Section: Resultsunclassified

Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

et al. 2021

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IMPORTANCEThe use of intercostal nerve block (ICNB) analgesia with local anesthesia is common in thoracic surgery. However, the benefits and safety of ICNB among adult patients undergoing surgery is unknown. OBJECTIVE To evaluate the analgesic benefits and safety of ICNB among adults undergoing thoracic surgery.DATA SOURCES A systematic search was performed in Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library databases using terms for ICNB and thoracic surgery (including thoracic surgery, thoracoscopy, thoracotomy, nerve block, intercostal nerves). The search and results were not limited by date, with the last search conducted on July 24, 2020.STUDY SELECTION Selected studies were experimental or observational and included adult patients undergoing cardiothoracic surgery in which ICNB was administered with local anesthesia via single injection, continuous infusion, or a combination of both techniques in at least 1 group of patients. For comparison with ICNB, studies that examined systemic analgesia and different forms of regional analgesia (such as thoracic epidural analgesia [TEA], paravertebral block [PVB], and other techniques) were included. These criteria were applied independently by 2 authors, and discrepancies were resolved by consensus. A total of 694 records were selected for screening. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items forSystematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data including patient characteristics, type of surgery, intervention analgesia, comparison analgesia, and primary and secondary outcomes were extracted independently by 3 authors. Synthesis was performed using a fixed-effects model. MAIN OUTCOMES AND MEASURESThe coprimary outcomes were postoperative pain intensity (measured as the worst static or dynamic pain using a validated 10-point scale, with 0 indicating no pain and 10 indicating severe pain) and opioid consumption (measured in morphine milligram equivalents [MMEs]) at prespecified intervals (0-6 hours, 7-24 hours, 25-48 hours, 49-72 hours, and >72 hours). Clinically relevant analgesia was defined as a 1-point or greater difference in pain intensity score at any interval. Secondary outcomes included 30-day postoperative complications and pulmonary function. RESULTSOf 694 records screened, 608 were excluded based on prespecified exclusion criteria.The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded. All of the 66 remaining studies (5184 patients; mean [SD] age, 53.9 [10.2] years; approximately 59% men and 41% women) were included in the qualitative analysis, and 59 studies (continued)

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“…values (Hatch, 1966;Bergh et al, 1966). In this respect, they resemble patients recovering from upper abdominal surgery, whose gas exchange is impaired by ventilation/perfusion (l?y$) mismatch rather than respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

Oxygen Therapy After Thoracotomy

Drummond¹,

Milne²

1977

British Journal of Anaesthesia

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SUMMARYArterial blood samples were taken from patients before thoracotomy, and on the 1st day after operation, with the patient breathing first air, and then 24%, 28% and 35% oxygen from a venturitype mask. Pao t was reduced markedly by operation, the reduction being related to the value before operation. Oxygen therapy restored P&o t to a value greater than the value before operation in nine of 11 patients and was not associated with significant increases in Paco,. The effect of administration of oxygen on Pao, could be predicted from the Pao t when breathing air. The pattern of response to oxygen suggested that the hypoxaemia was caused by ventilation/perfusion mismatch in most of the patients.Lung function is impaired severely after thoracotomy; arterial oxygen tension is reduced, and carbon dioxide tension may be increased, particularly within hours of the operation (Maier and Cournand, 1943; Bjork and Hilty, 1954;Hood and Beall, 1958;Knudsen, 1970). Opiate analgesia may increase the respiratory acidosis (Pandit, Galway and Dundee, 1973).Patients studied on the day after thoracotomy have persistent hypoxaemia, but reduced .Pa COl! values (Hatch, 1966;Bergh et al., 1966). In this respect, they resemble patients recovering from upper abdominal surgery, whose gas exchange is impaired by ventilation/perfusion (l?y$) mismatch rather than respiratory depression. Nevertheless, it is possible that, after thoracotomy, patients remain susceptible to respiratory depression, and that this is masked by the stimulus of hypoxaemia. The influence of controlled oxygen therapy on arterial oxygen and carbon dioxide tensions in such patients has not been reported.This study was designed to assess the effects of oxygen therapy after thoracotomy. The response of Pa Oa to different oxygen fractions (Fi Oi ) might indicate the mechanism of impairment of gas transfer (Kerr, 1975; Drummond and Wright, 1977). The difference between the calculated oxygen content of blood leaving the pulmonary capillaries (Cc'o 2 ) and the oxygen content of arterial blood (Ca Oj ) can be used as an index of impaired gas transfer, in the same way as the difference between alveolar and arterial oxygen tensions (PA 02 -Pa 02 ) has been used. The advantage of the former expression is that it is not changed by changes in alveolar oxygen tension if the impaired oxygenation is caused by the shunting of a constant fraction of blood through regions where it is not exposed to gas exchange. A reduction in the value of the index during administration of oxygen shows that increasing the alveolar oxygen tension improves the efficiency of oxygen transfer, which is characteristic of impaired exchange caused by fjQ mismatch (West, 1969). This analysis depends upon the assumption that the oxygen content difference between arterial and mixed venous blood (Ca 02 -Cv 02 ) is not changed by oxygen administration.If oxygen therapy were associated with an increase in PacQj,, this would suggest that respiration had been stimulated by hypoxia when the patient was breathing ai...

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Effect of Intercostal Block on Lung Function After Thoracotomy

Cited by 25 publications

References 8 publications

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy

Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

Oxygen Therapy After Thoracotomy

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