Infusion of Anesthetics Controls Pain Following Lung Surgery

A continuous infusion of local anesthetic just over the intercostal nerve substantially reduces pain and helps patients return to normal faster after thoracic surgery, claims a new study.

Researchers at the Washington Institute of Thoracic and Cardiovascular Surgery (Washington, DC, USA) reviewed the records of 300 thoracic surgery patients given subpleural infusions of 0.25% bupivicaine, at a rate of 2 cc per hour for 10 days. The infusion procedure involved two 12.7-cm catheters placed in a sub-pleural tunnel created by the surgeon, covering intercostal spaces two through eight. The researchers assessed postoperative pain using a 0-10 point Likert pain scale, comparing the results with a historical control group.

The results showed that pain rankings in the infusion group averaged 5 on post-op day one, 3 on day 14, and 1 on day 30, compared to 7.7, 6.8, and 4, respectively, in the control group. The median length of hospital stay in the infusion group was 4 days, not substantially different from the 5-6 day stay in the control group. However, return to normal function was substantially reduced, as was narcotic use for pain control. The study was presented at the annual international scientific assembly of the American College of Chest Physicians (ACCP), held during November 2010 in Vancouver (Canada).

"Usually systemic narcotics and epidurals are used to control pain after thoracic surgery. The problem is, epidurals are cumbersome, they wear off, and patients have to be in the hospital while they're being used. And narcotics have so many side effects,” said lead author and study presenter Barbara Tempesta, R.N., M.S. "The surgeons saw such a difference with the continuous infusions that they didn't want to do a randomized study.”

Significantly, the researchers found that the incidence of post-thoracotomy pain syndrome over a follow-up period of about 4 years was less than 3%; historically, however, about half of all patients undergoing thoracic surgery end up with chronic pain, and about 30% of patients might still experience pain 4-5 years later.

Related Links:
Washington Institute of Thoracic and Cardiovascular Surgery