Is intercostal block for pain management in thoracic surgery more successful than epidural anaesthesia?☆

Wurnig, P; Lackner, Henriette; Teiner, C.; Hollaus, Peter H.; Pospisil, M.; Fohsl-Grande, B.; Osarowsky, M.; Pridun, N

doi:10.1016/s1010-7940(02)00117-3

Cited by 55 publications

(51 citation statements)

References 9 publications

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“…Our findings that intercostal block patients experience hypotension less often are in accordance with previous research. Several studies suggest that hypotension is not observed frequently and that the incidence of hypotension is similar in both the thoracic epidural and the intercostal block groups [23][24][25]27]. We did not encounter any complications attributable to intercostal catheters.…”

Section: Discussionmentioning

confidence: 49%

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Sagiroglu¹,

Baysal²,

Kiraz³

et al. 2013

kitp

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StreszczenieCel pracy: Celem pracy było porównanie skuteczności ciągłe-go stosowania znieczulenia zewnątrzoponowego piersiowego oraz blokady międzyżebrowej do leczenia bólu po torakotomii. Materiał i metody: Sześćdziesięciu chorych ukończyło prospektywne badanie z randomizacją przeprowadzone metodą podwójnie ślepej próby. Pacjentów losowo przydzielono do grupy otrzymującej piersiowe znieczulenie zewnątrzoponowe (grupa 1., n = 30) lub blokadę międzyżebrową (grupa 2., n = 30) przez 24 godziny. W obu grupach podawano bupiwakainę o stężeniu 0,25% w ilości 5 ml/godzinę przy użyciu cewnika. W celu oceny bólu użyto wizualnej skali analogowej w spoczynku (VAS-R) i po kaszlu (VAS-C). Wyniki pobrano na począt-ku badania, jak również 1, 6 i 24 godziny po zabiegu. Zebrano także dane dotyczące zużycia morfiny, powikłań i efektów niepożądanych. Wyniki: Wartości VAS-R i VAS-C na początku były podobne, jednak wyniki uzyskane po upływie 1, 6 i 24 godzin były znacząco niższe w grupie 1. niż w grupie 2. (odpowiednio p = 0,017, p = 0,001, p = 0,023 dla VAS-R oraz p = 0,006, p = 0,002, p = 0,032 dla VAS-C). Zużycie morfiny na 24 godziny w grupie 1. było niższe w porównaniu z grupą 2. (p = 0,032). W grupie 1 u 5 z 30 pacjentów (17%) wystąpiło niedociśnienie, w grupie 2. nie zanotowano takich przypadków (p = 0,02). Wniosek: W przypadku bólu po torakotomii lepszą kontrolę analgezji uzyskuje się za pomocą znieczulenia zewnątrzopo-nowego piersiowego, jednak blokada międzyżebrowa stanowi alternatywę, ponieważ jest związana z mniejszą częstością występowania niedociśnienia. Słowa kluczowe: ból, torakotomia, znieczulenie zewnątrzopo-nowe piersiowe, blokada nerwu międzyżebrowego. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 244 ANAESTHESIOLOGY AND INTENSIVE CARE AbstractAim of the study: We aimed to compare the efficacy of the continuous use of thoracic epidural and intercostal analgesia for post-thoracotomy pain. Material and methods: Sixty patients completed a prospective, randomized, double-blinded study. The patients were randomized to receive thoracic epidural (group 1, n = 30) or intercostal block (group 2, n = 30) for 24 hours. In both groups, 0.25% bupivacaine was infused at a rate of 5 ml/h through an inserted catheter. Visual analog scale at rest (VAS-R) and after coughing (VAS-C) scores were recorded at baseline and at 1, 6 and 24 hours after surgery to evaluate pain. Morphine consumption, complications and side effects were recorded as well. Results: VAS-R and VAS-C scores were similar at baseline; however, 1 st , 6 th and 24 th hour scores of group 1 were significantly lower than the scores of group 2 (for VAS-R; p = 0.017, p = 0.001, p = 0.023, for VAS-C; p = 0.006, p = 0.002, p = 0.032, respectively). 24-hour morphine consumption was lower in group 1 in comparison to group 2 (p = 0.032). In group 1, 5 out of 30 patients (17%) experienced hypotension, compared with none in group 2 (p = 0.02). Conclusions: For post-thoracotomy pain, better control of analgesia is observed with the thoracic epidural technique; however, i...

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Section: Discussionmentioning

confidence: 49%

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Sagiroglu¹,

Baysal²,

Kiraz³

et al. 2013

kitp

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“…Torakotomi sonrası ağrıyı irdeleyen çalışmalarda ya bir analjezik yöntem diğeri ile kıyaslanmış, [16][17][18][19][20] ya da kombine analjezik yaklaşım ile tek bir analjezik yöntem kıyaslanmıştır. [6][7][8][9] Debreceni ve ark.…”

Section: Discussionunclassified

“…Benzer şekilde, Richardson ve ark. [19] da TSA'da belirgin düzeyde düşük [20] Literatürde epidural morfin uygulamasına karşı İSB'nin analjezik etkinliğini araştıran çalışmalar [17,19] olmasına karşın, çalışmamızda epidural morfin ve bupivakainle oluşturulan İSB kombinasyonu, tek başı-na epidural morfin uygulaması ile ilk kez kıyaslandı. Kombine analjezik tedavi uygulanan EİA grubunda ağrı skorları ve ameliyat sonrası epidural morfin tüketimi düşük bulundu.…”

Section: Discussionunclassified

The effect of intercostal nerve block on epidural analgesia in patients undergoing thoracotomy

Pinar¹

2012

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada, torakotomi uygulanan hastalarda ameliyat sırasında çok seviyeli interkostal sinir blokunun (İSB), ameliyat sonrası dönemde epidural morfin tüketimi ve analjezi kalitesi üzerine olan etkisi araştırıldı.Ça lış ma pla nı: Etik kurul onayı sonrası elektif torakotomi planlanan, 60 hasta (ASA sınıf I-III, 18-65 yaş); epidural analjezi (EA) grubu ve epidural+interkostal analjezi (EİA) grubu olmak üzere iki eşit alt gruba randomize olarak ayrıldı. Epidural analjezi grubunda torakotominin kapatıl-masından önce cerrahi kesi yerine, iki üst segmentin başlan-gıcından iki alt segmente kadar 10 ml %0.9 NaCl uygulandı. Epidural+interkostal analjezi grubunda ise aynı kesi yerlerine 10 ml %0.5 bupivakain uygulandı. Ameliyat sonrası analjezi, hasta kontrollü analjezi cihazı (bolus doz; 0.5 mg, kilit süresi; 30 dk.) yolu ile epidural morfin (0.1 mg/mL) ile sağlandı. Ameliyat sonrası dönemin ilk dört saatinde her saat, daha sonra 12, 24, 48. ve 72. saatlerinde hastaların ağrı skorları ve morfin tüketimleri kaydedildi.Bul gu lar: Gruplar arasında, cinsiyet (kadın hasta sayısı EİA grubu >EA grubu, p<0.05) dışında, başlangıç demografik özel-likler ve klinik karakteristikler açısından anlamlı fark saptanmadı (p>0.05). Epidural analjezi grubuna kıyasla, EİA grubunda; statik ağrı skorları (0, 1, 2, 3, 4, 12, 48. ve 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.

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“…The intercostal nerve blockade offers sufficient analgesia during video-assisted thoracoscopy [100]. The pre-, intra-, and postoperative intercostal block with bupivacaine reduces the morphine demand by 20 % but produces no comparable postoperative pain relief like TEA [102][103][104][105][106][107].…”

Section: Intercostal Nerve Blockadementioning

confidence: 99%

Recent Advances in Postoperative Pain Therapy for Thoracic Surgery

Loop

Harris

Grimm

2014

Curr Anesthesiol Rep

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Is intercostal block for pain management in thoracic surgery more successful than epidural anaesthesia?☆

Cited by 55 publications

References 9 publications

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

The effect of intercostal nerve block on epidural analgesia in patients undergoing thoracotomy

Recent Advances in Postoperative Pain Therapy for Thoracic Surgery

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