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Ann Thorac Surg 1993;55:377-380
© 1993 The Society of Thoracic Surgeons

Articles

Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia

Jonathan Richardson, FCAnaes, Sabaratnam Sabanathan, FRCS*, Jibah Eng, FRCS, Alan J. Mearns, FRCS, Christina Rogers, FCAnaes(I), Carolyn S. Evans, FCAnaes, Jane Bembridge, FCAnaes, Mohammed R. Majid, MBBS

Departments of Anaesthetics and Thoracic Surgery, Bradford Royal Infirmary, Bradford, England

Accepted for publication April 24, 1992.

* Address reprint requests to Mr Sabanathan, Department of Thoracic Surgery, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, England.

Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. Pulse oximetry monitoring was used to determine the incidence of hypoxemia. No significant difference was observed between the groups concerning pain relief (except at 28 hours, in favor of the intercostal nerve block group), respiratory performance, or arterial oxygen saturation. Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.




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