Effects of Continuous Intercostal Nerve Block Versus Patient-Controlled Intravenous Analgesia on Postoperative Pain After Video-Assisted Thoracoscopic Surgery.

BACKGROUND

Patients undergoing thoracoscopic surgery often suffer from acute and chronic pain that severely affects their quality of life. To mitigate this, continuous intercostal nerve block (CINB) and patient-controlled intravenous analgesia (PCIA) can be used. However, no studies have compared the analgesic effects of CINB vs. PCIA among patients following video-assisted thoracoscopic surgery (VATS).

OBJECTIVES

To compare the analgesic efficacy of CINB with that of PCIA after VATS.

STUDY

DESIGN

A prospective, randomized, controlled clinical trial.

SETTING

Department of Anesthesiology, Affiliated Hospital of Qingdao University.

METHODS

A total of 130 patients undergoing VATS were randomly assigned to the CINB or PCIA groups after the operation. The primary outcome was pain intensity assessed during rest and following coughing. This was measured using the visual analog scale (VAS) at 12, 24, 48, and 72 h, 2 months, and 3 months post-surgery. Secondary outcomes were adverse effects, location of pain, analgesic rescue, and patient satisfaction.

RESULTS

Pain scores on rest and coughing 72 h after operation, as well as the VAS at 2 months post-VATS, were significantly lower in the CINB group than those in the PCIA group. The rates of surgical incision pain at 72 h and 2 months after surgery were significantly decreased in the CINB group compared with those in the PCIA group. Patients in the CINB group had a significantly lower incidence of adverse reactions, needed less analgesic rescue, and had higher satisfaction than those in the PCIA group.

LIMITATIONS: The limitations of this study include its short follow-up period and the single-center design.

CONCLUSIONS

CINB for patients undergoing VATS was superior to PCIA according to pain score, adverse effects, analgesic rescue, and patient satisfaction. CINB may be a viable alternative pain management for patients after VATS.