Intraoperative intercostal nerve block provides quick postoperative analgesia, finds study

In the realm of thoracic surgery, video-assisted thoracoscopic surgery (VATS) has supplanted thoracotomy because VATS reduces postoperative discomfort more effectively than thoracotomy. A number of surgeons have recently proved that a VATS can be performed using a single incision. Compared to multiport VATS, uniport VATS has shown positive results to far. Nevertheless, postoperative discomfort remains the primary issue for thoracic procedures. A recently published research assessed the effect of intraoperative intercostal nerve block on the postoperative discomfort of patients receiving uniportal VATS, particularly wedge resection, with intraoperative intercostal nerve block.

All patients who had uniportal VATS wedge resection between January 2019 and March 2020 were retrospectively evaluated. Twenty patients in Group A had uniportal VATS wedge resection without intraoperative intercostal nerve block. Twenty more consecutive Group B patients had uniportal VATS wedge resection with intraoperative intercostal nerve block. Postoperatively, the numeric pain rating scale (NRS) values were measured at 1, 12, and 24 hours. In addition, the number of opioids used up to the moment of chest tube removal was noted. There were no significant differences between groups for sex, age, chest tube duration, length of stay, surgical time, laterality time, or diagnosis. Postoperative NRS scores were significantly different across groups at 1 h (P = 0.001) and 12 h (P = 0.022). In Group B, opioid usage was considerably lower than in Group A (P = 0.025).

The intraoperative intercostal nerve block with bupivacaine offered rapid postoperative pain relief and decreased postoperative opioid intake in comparison to patients who received uniportal VATS, particularly wedge resection of the lung. The precision of the intraoperative intercostal nerve block is a benefit. Under direct observation, local anaesthetic injections are administered, and a parietal pleural bulge is seen across the intercostal area. In this research, injections were administered at different levels, from the third to the seventh intercostal space, to reduce the discomfort produced by the uniport performed through the fifth intercostal space.

Reference –

Kang DK, Kang MK. A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung. Ann Thorac Med 2022;17:180-3.