The Effects Of Intercostal Nerve Blockade With Compound Lidocaine Combined With Patient Controlled Intravenous Analgesia On Post- Thoracotomy Pain

Objective: To observe the analgesic effects of intraoperative intercostal nerve blockade with compound lidocaine on post-thoracotomy pain.Method: 80 patients underwent radical surgery of esophageal carcinoma were randomized into 4 groups with 20 patients each. Postoperatively the patients received continuous intravenous fentanyl infusion without intercostal nerve blockade in the Group I, continuous intravenous fentanyl infusion and intercostal nerve blockade with compound lidocaine in the Group CL, continuous intravenous fentanyl infusion and intercostal nerve blockade with 0.375% ropivacaine in the Group R, and continuous intravenous fentanyl infusion and intercostal nerve blockade with 0.8% lidocaine in the Group L. Visual analogue score (VAS) and Prince-Henry(P-H) pain scores were used to evaluate the pain severity. The vital signs and complications were also recorded by an anesthetist who was blind to the groups. Chronic pain was also followed up 4 months later.Results:1.The VAS score and P-H scores: There were significant difference in VAS score and P-H score among the four groups (P<0.05). Compared with patients in the I-group, less pain was felt in the other three group(P<0.05). The VAS scores and P-H scores had no significant difference among patients with intercostal nerve block in the first postoperative hour, which was lower in the CL-group when compared with the other two groups 4 and 24 hours postoperatively. No significant difference was observed between patients in R-group and L-group at the same time. Forty eight and 72 hours postoperatively, the patients in the CL-group still showed the best analgesia effects, however the VAS score and P-H score in the L-group became worse and was comparable to the I-group.2. The supplemental use of analgesics: The patient needed least supplemental use intravenous analgesics in the CL-group, less in the R-group and most in the I-Group. The use of rescue pethidine: There was significant difference among the four groups. The patients in the I-group consumed more pethidine than the others as the patients requested.3. The ability of cough and expectoration: when asked to cough and expectorate, patients in CL-group and R-group had better obedience than the others, there were no obvious difference between CL-group and R-group.4. The chronic pain after thoracotomy: the rate of chronic pain had no obvious difference among the four groups.5.No side effect was observed related to compound lidocaine intercostal block. Conclusion: Compound lidocaine can be safely used for post-thoacotomy analgesia by intercostal nerve block and maybe have more advantage than ropivacaine.