Continuous Intercostal Nerve Block For Single Portal Video-assisted Thoracoscopic Surgery Of Primary Spontaneous Pneumothorax
Tzu-Ping Chen, Sr.1, Chi-Hsiao Yeh1, Yen-Hun Liu2.
1Chang Gung Memorial Hospital, Keelung, Taiwan, 2Chang Gung Memorial Hospital, Taoyuan, Taiwan.
BACKGROUND: Single portal VATS is widely used for primary spontaneous pneumothorax. Postoperative pain is less after single-portal VATS. We aimed to verify the clinical effects of continuous intercostal neve block (CINB) in patients with primary spontaneous pneumothorax (PSP).
METHODS: We reviewed the records of 65 patients who had single portal VATS bullectomy for primary spontaneous pneumothorax between March 2012 and August 2016. Thirty-five patients were identified with continuous intercostal nerve block (CINB) and compared with 30 patients without CINB. Clinical Variables; pain score; supplemental narcotic utilization from postoperative day 0, 1, 2, 3, 4; postoperative airleak; apical lung atelectasis; and hospital length of stays were compared in the two groups.
RESULTS: In all, 30 patients in the CINB group had similar clinical data compared to 35 in the group without ICNB. No complication related either to the procedure or to the infusion of bupivacaine occurred. There were statistically significant lower mean pain scores on day 0, 1, 2, 3, 4 (P<0.001, <0.001, 0.008, 0.01, 0.001). The median operation time, duration of chest tube drainage, and supplementary narcotic utilization was not different between 2 groups.
CONCLUSIONS: Thoracoscopic intercostal nerve block with continuous infusion of bupivacaine 0.5% is safe and effectively reduced the postoperative pain of single portal VATS for primary spontaneous pneumothorax. Further prospective trials are needed to determine the long term outcomes.
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