Abstract
BackgroundWell-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS.MethodsIn this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay.ResultsNo technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days.ConclusionsIncorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.
Highlights
Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS)
Despite the usage of such techniques, significant acute postoperative pain has still been reported after UVATS [21, 22] and this is thought to be due to the irritation of the pleura or neurovascular bundles by chest tubes [23,24,25]
This has resulted in paravertebral blocks (PVB) becoming more appealing than thoracic epidural analgesia (TEA), but studies have revealed that a continuous infusion technique rather than a single-shot blockade resulted in the decreased need for opioids and more optimal pain control [28, 29]
Summary
Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. Pain management in thoracic surgery is essential to promote early recovery and avoid complications like urinary retention, atelectasis and pneumonia. Studies have demonstrated that both TEA and PVB provide adequate analgesic effect after major thoracic surgery, but the former may be associated with adverse effects such as urinary retention and hypotension [2,3,4,5]. The placement of an intercostal catheter (ICC) has been explored as a regional analgesic option. The ICC has been shown to achieve good postoperative pain control in abdominal and orthopaedic surgeries [8,9,10], but evidence on its utility in thoracic surgery is mixed [11,12,13]
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