PURPOSE: Postoperative pain relief is paramount for decreasing complications following thoracic surgery. Although systemic narcotics and epidural catheters provide excellent pain relief, they are hampered by a number of complications. The complications include somnelence with narcotics, and insertion and infusion side effects as well as return of pain after epidural catheter removal. Direct prolonged intercostal pain relief with continuous infusion of local anesthetic represents an attractive alternative to these techniques. We compared transcatheter subpleural infusion of local anesthetic to conventional pain relief techniques after thoracic surgery.
METHODS: We devised a technique for the placement of two 5 inch on-Q Pain Buster catheters in tandem in a subpleural tunnel encompassing intercostal spaces 2-8. The catheters are connected to the on-Q elastomeric reservoir with a regulator valve for infusion of 0.5% bupivacaine at 2ml/catheter/hr. The catheters were used for 5 days. Over a 4 month period 24 patients (9 men, 15 women) underwent subpleural catheter infusion (SPC) following thoracic surgery. These patients were retrospectively compared to historic controls (C) who had conventional pain control. Postoperative pain control was scored using the Likert Pain scale (0-10). The total use of narcotic analgesics was quantitated.
RESULTS: There were no complications related to the insertion of the catheter. Postoperative pain as measured by the Mean Likert Score was: Day 1 (C=7.9 vs. SPC= 3.9, p<0.05), Day 14 (C=7.3 vs. SPC=1.9, p<0.05), Day 30 (C=5.4 vs. SPC=0.8, p<0.05). Postoperative narcotic use was significantly lower in the SPC patients (SPC=46 +/- 6.2 pills vs. C =161+/- 8.4 pills, p<0.05).
CONCLUSION: Prolonged subpleural catheter infusion of local anesthetic may represent an alternative to narcotics and epidural catheters for pain control after thoracic surgery.
CLINICAL IMPLICATIONS: Postoperative pain relief is the most important factor in decreasing morbidity following thoracic surgery. Prolonged subpleural catheter infusion of local anesthetic with a system devised for outpatient use may decrease the complications associated with the present pain relief strategies and even result in shorter hospitalization and greater patient satisfaction.
DISCLOSURE: Barbara Tempesta, No Financial Disclosure Information; No Product/Research Disclosure Information