A Comparison of Intercostal Nerve Block and Thoracic Epidural Anesthesia in Patients Undergoing Video-Assisted Thoracic Surgery: A Propensity Score-Matched Retrospective Study

TL;DR

This study compares two pain management methods after chest surgery and finds that one method provides better pain relief than the other.

Contribution

The study evaluates the effectiveness of intercostal nerve block plus IV PCA versus thoracic epidural anesthesia for postoperative pain in VATS patients.

Findings

The ICNB group had higher pain scores on postoperative day 1 compared to the TEA group.

Patients receiving ICNB used rescue analgesics more frequently on postoperative day 0.

The ICNB group had a higher rate of antiemetic use on postoperative day 1.

Abstract

Background: Intercostal nerve block (ICNB) plus intravenous (IV) patient-controlled analgesia (PCA) could be an alternative method of perioperative pain management in patients undergoing video-assisted thoracic surgery (VATS). However, the efficacy of this strategy has not been established.

Methods: A retrospective observational study was conducted at an acute care hospital in Japan. Among patients who underwent VATS under general anesthesia from January 1, 2012, to December 31, 2022, we included those who received ICNB or thoracic epidural anesthesia (TEA). The ICNB group had postoperative IV PCA, and the TEA group had postoperative epidural PCA. VATS indicated for pneumothorax or biopsy was excluded. The primary outcome was the maximum pain score measured by the numerical rating scale on postoperative day 1. Secondary outcomes included the times rescue analgesics were used and the use of antiemetics. Propensity score matching was performed to minimize bias from nonrandomized assignment of anesthesia methods.

Results: Among 1,641 patients who met the criteria, 590 underwent ICNB and IV PCA, while 1,051 received TEA. After 1:1 propensity score-matching, 456 were in each group. The median (interquartile range) pain score on postoperative day 1 was higher in the ICNB group than in the TEA group, with values of 5 (4-7) vs. 3 (2-5) (p < 0.0001). Patients in the ICNB group more frequently used rescue analgesics on postoperative day 0, with values of 2 (1-2) vs. 1 (1-2) (p < 0.0001), and had a higher proportion of receiving antiemetics on postoperative day 1 (13.4% vs. 6.1%, p = 0.0004), compared to the patients in the TEA group.

Conclusions: ICNB plus IV PCA was inferior to TEA for postoperative pain management of VATS in the study population. Protocol-based prospective studies are needed to determine the efficacy of this strategy.

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