PURPOSE: Postoperative pain relief is paramount for decreasing complications after thoracic surgery. Systemic narcotics and epidurals provide excellent relief but are hampered by complications such as somnolence, insertion and infusion side effects, and return of pain after removal. Direct prolonged intercostal pain relief with continuous infusion of local anesthetic is an alternative to conventional pain relief techniques.
METHODS: Over a 62 month period 300 patients who underwent thoracic surgery underwent this technique for subpleural infusion of a local anesthetic via a specially created subpleural tunnel where two five inch catheters are inserted, covering intercostal spaces two through eight. 0.25% Bupivicaine is infused at 2cc/hr via each catheter for a ten day duration. Efficacy of pain control was evaluated in terms of a Likert pain scale ranking as well as length of stay and return to activities of daily living.
RESULTS: Post-operative pain ranked on post-op day 1, 14 and 30 was 7.7, 6.8, and 4.0 respectively for the control group and 5.0, 3, and 1 for the study group; all p < 0.05. Median length of stay was 4 days and median return to normal activities was 17 days. Incidence of long term pain syndrome was less than 3%.
CONCLUSION: Prolonged subpleural catheter infusion of local anesthetic with a system devised for outpatient use may represent a superior pain control technique with greater patient satisfaction and shorter hospitalization and lower incidence of post thoracotomy pain syndrome.
CLINICAL IMPLICATIONS: This technique represents an effective alternative to other methods of pain control that patients can use outside the hospital setting.
DISCLOSURE: Barbara Tempesta, No Financial Disclosure Information; No Product/Research Disclosure Information