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BACKGROUND: Postoperative pain relief is paramount for decreasing complications after thoracic surgery. Systemic narcotics and epidurals provide excellent relief but are hampered by complications such as somnolence, insertion and infusion side effects, and return of pain after removal. Direct prolonged intercostal pain relief with continuous infusion of local anesthetic is an alternative to conventional pain relief techniques.
METHODS: Over a 62 month period 300 patients who underwent minimally invasive thoracic surgery had a subpleural infusion of a local anesthetic via a specially created subpleural tunnel where two five inch catheters were inserted, covering intercostal spaces two through eight. Bupivicaine (0.25%) was infused at 2cc/hr via each catheter for a ten day duration. Efficacy of pain control was evaluated in terms of a Likert pain scale, length of hospital stay and return to activities of daily living.
RESULTS: The Likert pain score for the control group was 7.7, 6.8, and 4.0 on postoperative days 1, 14, and 30 respectively. In comparison, the Likert pain score for the experimental group was 5.0, 3.0, and 1.0 on postoperative days 1, 14, and 30 respectively (Table 1)
In the group undergoing infusion of local anesthetic (experimental group), median length of stay was 4 days and median return to normal activities was 17 days. Incidence of long term pain syndrome was less than 3%.
CONCLUSION: Prolonged subpleural catheter infusion of local anesthetic with a system devised for outpatient use may represent a superior pain control technique with greater patient satisfaction, shorter hospitalization and lower incidence of post thoracotomy pain syndrome.

Likert pain score comparison between control and experimental groups

	Control	Experimental	p-value
Post-operative day 1	7.7	5.0	<.05
Post-operative day 14	6.8	3.0	<.05
Post-operative day 30	4.0	1.0	<.05