Journal
PAIN MEDICINE
Volume 18, Issue 6, Pages 1152-1160Publisher
OXFORD UNIV PRESS
DOI: 10.1093/pm/pnw149
Keywords
Acute Pain; Thoracic; Postoperative Pain; Steroids; Outcome Assessment
Categories
Funding
- NIH
- Wellcome Trust
- Howard Hughes Medical Institute
Ask authors/readers for more resources
Objective. The use of multiple-level, single-injection intercostal nerve blocks for pain control following video-assisted thorascopic surgery (VATS) is limited by the analgesic duration of local anesthetics. This study examines whether the combination of perineural and intravenous (IV) dexamethasone will prolong the duration of intraoperatively placed intercostal nerve blocks following VATS compared with IV dexamethasone and a perineural saline placebo. Design. Prospective, double-blind, randomized placebo-controlled trial. Setting. Single level-1 academic trauma center. Subjects. Forty patients undergoing a unilateral VATS under the care of a single surgeon. Methods. Patients were randomly assigned to two groups and received an intercostal nerve block containing 1) 0.5% bupivacaine with epinephrine and 1ml of 0.9% saline or 2) 0.5% bupivacaine with epinephrine and 1ml of a 4 mg/ml dexamethasone solution. All patients received 8mg of IV dexamethasone. Results. Group 2 had lower NRS-11 scores at postoperative hours 8 (5.05, SD=2.13 vs 3.50, SD=2.50; p=0.04), 20 (4.30, SD=2.96 vs 2.26, SD=2.31; p=0.02), and 24 (4.53, SD=1.95 vs 2.26, SD=2.31; p=0.02). Equianalgesic opioid requirement was decreased in group 2 at 32 hours (5.78 mg, SD55.77 vs 1.67 mg, SD=3.49; p=0.02). Group 2 also had greater FEV1 measured at 8, 12, 24, and 44 hours; greater FVC at 24 hours; greater PEF at 28 through 48 hours; and greater FEV1/FVC at 8 and 36 hours. Conclusions. The combination of IV and perineural dexamethasone prolonged the duration of a singleinjection bupivacaine intercostal nerve block as measured by NRS-11 compared with IV dexamethasone alone at 24 hours. Reduced NRS-11 at other times, reduced opioid requirements, and increased PFTs were observed in group 2.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available