• Ruth Taylor, Simon Massey, and Karen Stuart-Smith.
• Department of Anaesthesia, Bristol Royal Infirmary, Bristol, United Kingdom.
• J. Cardiothorac. Vasc. Anesth. 2004 Jun 1; 18 (3): 317-21.

ObjectivesThis study examined (1) the opioid and nonopioid requirement of patients undergoing video-assisted thoracoscopy (VATS) as a measure of postoperative pain and (2) whether percutaneous intercostal blockade might reduce morphine requirements and improve analgesia in VATS procedures.DesignA combined retrospective and prospective study.SettingA university teaching hospital.ParticipantsPatients undergoing VATS procedures.InterventionsA retrospective analysis of 26 sequential patients; perioperative intercostal blockade with bupivacaine, either with or without dextran 40, in 26 prospective patients.Measurements And Main ResultsRetrospective: opioid and nonopioid analgesic requirements of 26 sequential patients who had undergone VATS surgery without intercostal blockade were determined from a study of the case records. Twenty-six additional patients undergoing VATS surgery by the same surgeon were randomly divided to receive either percutaneous intercostal nerve block using plain bupivacaine 0.375% or bupivacaine 0.375% in dextran 40. The duration of local anesthesia was assessed. Postoperative opioid and nonopioid analgesic requirements were compared with the retrospective group.ConclusionsPostoperative morphine requirements after VATS surgery are considerable, with pleurectomy being the most painful procedure. Intercostal blockade with bupivacaine provided effective pain relief and a dramatic reduction in morphine requirements. This technique is recommended for VATS surgery, especially if day-case procedures are being contemplated.

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