Value of Combining Intercostal Block by the Operating Surgeon with Other Pain Control Modalities on Post-thoracotomy Pain Management

Abstract

Background: In current medical practice conventional thoracic surgery is one of the most painful surgeries due to significant post- thoracotomy pain that can lead to post-operative diaphragmatic dysfunction and respiratory compromise.

Aim: This study aimed to evaluate the efficacy of intercostal block when combined with thoracic epidural analgesia and other modalities for control of post-thoracotomy pain in conventional thoracic surgery.

Patients and methods: This retrospective single-center study included 500 cases of conventional thoracic surgery done at the  Cardiothoracic Surgery Department, Tanta University through the period from January 2018 to January 2023. Cases were divided into 5  groups each group included 100 patients. Group A (Patients received medications without intercostal block), group B (Intercostal block combined with medical treatment), group C (Intercostal block combined with thoracic epidural analgesia), group D (intercostal block  combined with sacrospinalis block) and group E [intercostal block combined with postoperative patient-controlled analgesia pump  (PCA)].

Results: There was a significant difference in favor of (group E) regarding the post-operative volume achieved on spirometer (P =  0.044), post-operative pain severity score and length of hospital stay (P < 0.001). But there was no significant difference as regards  fentanyl requirement (P = 0.499), length of ICU stay and morbidity and mortality (P = 0.938, 0.113, 1.0) respectively.

Conclusions:  Combining intercostal block with patient-controlled analgesia pump "PCA” achieved a superior level of postthoracotomy pain control  followed by combined intercostal block with sacrospinalis block and both were superior to the lone use of pain medications, intercostal  block with medical treatment or with thoracic epidural analgesia.