Introduction and Objectives
 
Thoracic Epidural (TE) and Paravertebral Block are the gold standard for intra and postoperative pain management in thoracic surgery, with plenty of evidence about their use in thoracotomy. However, their utility in VATS (Video-assisted thoracoscopic surgery) is being questioned, as there are thoughts that a less invasive surgery should require a less invasive pain management technique too.
Our study’s main objective is to determine the effect of Intercostal Block (ICB) in postoperative pain scores during the first 48h after VATS surgery, compared with TE.
 
Material and methods

We retrieved records from 42 patients who had undergone VATS for lobectomy in the past 5 months from our hospital’s data base. They were divided in two groups of 21: in the first one, the surgeon had performed an ICB with Bupivacaine 0.5%; in the second group, a TE catheter had been placed, followed by a continuous infusion of Ropivacaine 0.2%.
We reviewed data about postoperative pain, both in rest and movement, registered at each nursing shift: admission into the ICU, evening and midnight the same day, at 8.00am and noon the following day, and 48h after the surgery, using the VAS (Visual Analog Scale) for pain. Morphine administration was also documented.
 
Results 
 
Both groups were homogeneous with an mean age of 62 years and an ASA score of II. The median VAS score at rest for the TE group (p25-p75) was, for each time (admission, evening, midnight, 8.00am, noon and 48h post-surgery): 2(0-5); 2(0-5); 1(0-5); 1(0-3,75); 1(0-2); and 0(0-2). For the ICB group, the medians (p25-p75) were 2(0-5,75); 1,5(0-5); 1(0-5); 1(0-4); 1(0-3) and 0.5(0-2), respectively. Statistically significant differences were not found on either side.
On the other hand, the medians for VAS score in motion were as follow: for the TE group, 4(1,5-7,75); 5(2,25-6,75); 5(2,25-7); 4(2-5); 2,5(1,25-5) and 2,5(2-3,75). And for the ICB group, 3,5(0-6,5); 4(1-6); 4(1,75-5,5); 4(2-5,25); 4(3-5,25) and 2(1-4,25). There weren’t any significant differences detected between both sides either.
 
Conclusions
 
Overall, both groups presented similar VAS score after the first 48h after the surgery. No distinction was found in terms of rescue analgesia for both techniques either.
Ultimately, we found ICB provides postoperative analgesia comparable to TE in VATS, and therefore it could become the procedure of choice for this kind of surgery. 


05 / Thoracic epidural vs intercostal block for postoperative pain management in VATS (Video-Assisted Thoracoscopic Surgery)