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International Society For Minimally Invasive Cardiothoracic Surgery

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Effect Of Intrathoracic Nerve Block On Patient Controlled Analgesia Following Robotic Assisted Pulmonary Wedge Resection: A Comparative Study
Alainna Simpson1, Katie Mettler1, Peter Baik2.
1Oklahoma State University Medical Center, Tulsa, OK, USA, 2Cancer Treatment Center of America, Tulsa, OK, USA.

Background: The study objective was to determine if application of intrathoracic intercostal block during robotic assisted pulmonary wedge resection ultimately reduced the amount of opioids needed to provide adequate analgesia in the immediate post-operative period.
Methods: Over three years, the charts of 98 patients who underwent robotic assisted pulmonary wedge resection at three institutions were retrospectively reviewed. Two cohorts of patients were ultimately compared: those who received an intrathoracic block plus patient-controlled analgesia (PCA) pump for analgesia (50) and those who received only a PCA pump (48). Charts were reviewed to determine the average pain score of each patient, number of PCA demands, number of PCA doses and the amount of PCA nursing boluses needed to provide adequate analgesia. Using a Mann-Whitney test for unpaired data, each category was directly compared across the two cohorts.
Results: The charts of 98 total patients were retrospectively reviewed from September 2016 to August 2019. Patients were eligible if they underwent a robotic assisted pulmonary wedge resection. There were no significant differences among the two groups regarding demographics including age, gender, past medical or surgical history, indication for surgery, smoking status, chronic use of opioid medications or use of adjunctive medications for improved pain control. After direct comparison, the average pain score (2.48 vs 2.39, p=0.52), number of PCA demands (57.78 vs 46.45, p=0.38), and amount of PCA boluses (3.82 vs 1.27, p=0.06) for patients who received a block was slightly lower, however there was no statistical significant differences between the two cohorts. Patients who received a block actually had a slight increase in the number of PCA doses delivered (25.39 vs 29.18, p=0.18), but again this was not found to be statistically significant.
Conclusion: The opioid epidemic is one of the worst public health crises of our lifetime. Many strategies are being implemented to combat this problem including increased application of multimodal pain control regimens that emphasize non-opioid medications and greater utilization of peripheral and regional anesthesia. Although an intrathoracic intercostal nerve block can be quickly applied intraoperatively at the conclusion of minimally invasive thoracic surgery, it did not appear to improve the post-operative analgesia for patients or decrease the amount of opiates needed to control pain. Going forward, other methods of regional anesthesia should be considered over the intrathoracic intercostal nerve block.

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