Intercostal Nerve Blockade Combined With Patient-Controlled Intravenous Analgesia For Pain Relief After Video-Assisted Thoracoscopy

Objectives The purpose of this study is to asses the effect of intercostal nerve blockade associated with patient-controlled intravenous analgesia for pain relief after video-assisted thoracoscopy.Methods Twenty-eight ASAⅠandⅡpatients,aged between 19 to 65 years old, undergoing elective video-assisted thoracoscopy were randomized into two groups. An intercostal nerve block with ropivacaine 0.375%was applied at the end of the operation by surgeons in the INB+PCIA group,while the PCIA group received 0.9% saline.Postoperative pain management was the same in both groups with patient-controlled intravenous analgesia with fentanyl.Main outcome was pain evaluated with 'Visual Analog Score' within 48 hours after video-assisted thoracoscopy at rest and moving like coughing.The cumulative amount of intravenous fentanyl used,and blood pressure and heart rate within 48 hours,and satisfactory as well as postoperation nausea and vomiting were the secondary outcomes.Results There were no significant differences between patients of Group INB+PCIA and Group PCIA regarding age,sex and number of chest tube insertion after video-assisted thoracoscopy.Mean postoperative pain measured by 'Visual Analog Score' were as follows:0.9±1.0 and 2.4±1.6 at 4 h at rest and coughing,1.4±1.3 and 3.1±1.6 at 24 h at rest and coughing,1.1±1.4 and 2.7±1.8 at 48 h at rest and coughing in Group INB+PCIA;and 3.1±1.9 and 4.7±2.1 at 4 h at rest and coughing,2.4±1.8 and 5.5±2.1 at 24 h at rest and coughing,1.6±1.7 and 3.8±2.4 at 48 h at rest and coughing in Group PCIA.Differences were significant at 4 h at rest and coughing,and at 24 h at coughing(p＜0.01),while there were no differences between groups at 24 h at rest,and at 48 h at rest and coughing.Patients receiving INB were more satisfied than those in the PCIA group,and needed less fentanyl within 48 hours(p＜0.05).Patients' blood pressure and heart rate in Group INB+PCIA at 4 h and 24 h were lower than those of Group PCIA(p＜0.05).And there were no differences between groups about blood pressure and heart rate at 48 h. Supplementary analgesia was required during the first two postoperative days in two patients in Group PCIA while no patients in Group INB+PCIA(p＞0.05).There were also no differences between groups about postoperation nausea and vomiting.In both groups,no complications were observed.Conclusion Intercostal nerve block with ropivacaine 0.375%during video-assisted thoracoscopy combined with patient-controlled intravenous analgesia with fentanyl is effectively reducing the immediate postoperative pain within 24 hours and analgesic requirements.