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Ann Thorac Surg 1993;55:381-385
© 1993 The Society of Thoracic Surgeons

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Articles

Continuous intercostal analgesia with 0.5% bupivacaine after thoracotomy: A randomized study

Service de Chirurgie Thoracique, Départment de Kinesitherapie, et Laboratoire d'Explorations Fonctionnelles Respiratoires, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Le Plessis Robinson, France

Accepted for publication August 26, 1992.

^_* Address reprint requests to Dr Hervé, Laboratoire d'Explorations Fonctionnelles Respiratoires, Centre Chirurgical Marie Lannelongue, 133 Avenue de la Resistance, Le Plessis Robinson, 92350 France.

This study was undertaken to evaluate the effectiveness of 0.5% bupivacaine (360 mg/day) as a continuous infusion through an indwelling intercostal catheter inserted intraoperatively in the management of pain after thoracotomy. Eighty-six patients were randomized into three groups: group 1 = intercostal bupivacaine, group 2 = intercostal saline solution, and group 3 = fixed-schedule intramuscular buprenorphine. Supplementary buprenorphine was given as required. Pain and pulmonary function were assessed throughout the first 5 days after operation. Pain score was lower in group 1 than in group 2 for the first 8 hours after operation (p < 0.02). During the first 3 postoperative days, mean postoperative pain scores of 5 or more were recorded in 9% of group 1 patients versus 40% of group 2 patients (p < 0.05) and 13% of group 3 patients (not significant). Total doses of buprenorphine were lower in groups 1 and 2 than in group 3 (p < 0.001). No between-group differences in pulmonary function were observed. Respiratory complications occurred in no patients in groups 1 and 3 versus 5 in group 2 (p < 0.05). Continuous intercostal bupivacaine provided similar early pain control as compared with fixed-schedule narcotics but induced better analgesia with fewer complications than on-demand narcotics alone (group 2).

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