Continuous extrapleural intercostal nerve block with continuous infusion of lidocaine after thoracotomy: A descriptive pilot study

E. Sullivan, F. W. Grannis, B. Ferrell, M. Dunst

Research output: Contribution to journalArticle

Abstract

Continuous extrapleural intercostal block (EPIB) with bupivacaine has been reported to be an effective analgesic technique in patients after thoracotomy. We report a retrospective study of EPIB using a continuous infusion of 1% lidocaine hydrochloride at a dose of 1 mg/kg/h. A posterior parietal pleural pocket was created and cannulated with a 16-g polyethylene catheter. Lidocaine was perfused over a 3-day period following surgery. Patients also had access to morphine sulfate via patient-controlled analgesia. Eighteen consecutive posterolateral thoracotomies (in 17 patients) performed during a 6-month period were reviewed. Serum lidocaine exceeded the toxic level of 5 μg/mL in only one patient, a 104.5-kg man who had a level of 5.9 pg/mL on postoperative day 2 but experienced no clinical toxicity. Pain was evaluated by verbal analog scores (0=no pain and 10=worst pain), which averaged 3.02, 3.14, and 2.8 in the 3 days following surgery. Mean total daily MS doses were 24.3, 37.75, and 34.32 mg (range, 0 to 94 mg). Sedation was scored on a 1 to 5 scale. Mean scores were 2.78, 2.56, and 2.6. No patient died or had a major respiratory complication. Continuous EPIB with lidocaine appears to be a promising adjuvant technique in the management of postthoracotomy pain. Effectiveness needs to be confirmed in a prospective randomized study.

Original languageEnglish (US)
Pages (from-to)1718-1723
Number of pages6
JournalCHEST
Volume108
Issue number6
DOIs
StatePublished - Jan 1 1995

Keywords

  • analgesia
  • intercostal nerves
  • lidocaine
  • local anesthesia
  • nerve block
  • pain measurement
  • postoperative pain
  • thoracic surgery
  • thoracotomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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