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Ann Thorac Surg 2005;80:1550-1559
© 2005 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina
Accepted for publication November 24, 2004.
* Address reprint requests to Dr Detterbeck, Division of Cardiothoracic Surgery, University of North Carolina, CB 7065, Medical School Wing C—Room 354, Chapel Hill, NC 27599-7065 (Email: fdetter{at}med.unc.edu).
Intercostal nerve blockade for postthoracotomy pain relief can be accomplished by continuous infusion of local anesthetics through a catheter in the subpleural space or through an interpleural catheter, by cryoanalgesia, and by a direct intercostal nerve block. A systematic review of randomized studies indicates that an extrapleural infusion is at least as effective as an epidural and significantly better than narcotics alone. The other techniques of intercostal blockade do not offer an advantage over narcotics alone.
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