Comparıson of On-Q Intercostal Elastomerıc Pump System and Intravenous Analgesıa Methods for Paın Management after Thoracotomy.

BACKGROUND

Thoracotomy has been defined as one of the most painful surgical procedures. Inadequate pain control increases morbidity, hospital costs, and hospital length of stay.

AIM: We aimed to compare the results of continuous infusion of local anesthetics through an intercostal On-Q (ICOQ) elastomeric pump under the pleura or intravenous analgesia to manage post-thoracotomy pain.

METHODS

We performed a prospective comparative analysis of 149 consecutive patients who underwent anterolateral thoracotomy between January 2018 and October 2021. Postoperative pain management with a continuous infusion elastomeric pump providing local anesthetic into the intercostal area was compared with intravenous analgesia. Patients received either the ICOQ elastomeric pump system (n = 73) or intravenous analgesia (n = 76) for the first 48 postoperative hours. Visual Analog Scale (VAS) rescue patient-controlled analgesia morphine consumption, hemodynamic, and side effects were evaluated within 48 hours.

RESULTS

The VAS scores of the IV group at 1, 4, 12, 24, 36, and 48 hours were statistically significantly higher than the On-Q group. ( P = 0.028, P = 0.041, P = 0.011, P = 0.001, P = 0.021, P = 0.017, respectively postoperative complications occurred in 17 (23%) patients in the ICOQ group, and 34 (45%) patients in the IV group. There was no significant difference between the two groups in terms of postoperative complications except for nausea and vomiting.

CONCLUSION

Continuous analgesia using the ICOQ is an effective analgesia method for postoperative pain control for thoracotomy procedures that reduces pain scores and additional opioid consumption.