Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Analgesic effect of intercostal nerve block given preventively or at the end of operation in video-assisted thoracic surgery: a randomized clinical trial

Efeito analgésico do bloqueio do nervo intercostal administrado preventivamente ou no final da operação em cirurgia torácica videoassistida: ensaio clínico randomizado

Weizhang Xiao; Weiwei Zhou; Xinming Chen; Jun Zhu; Qun Xue; Jiahai Shi

Downloads: 0
Views: 331


To compare the analgesic effect of intercostal nerve block (INB) with ropivacaine when given preventively or at the end of the operation in patients undergoing video-assisted thoracic surgery (VATS).

A total of 50 patients undergoing VATS were randomly divided into two groups. The patients in the preventive analgesia group (PR group) were given INB with ropivacaine before the intrathoracic manipulation combined with patient-controlled analgesia (PCA). The patients in the post-procedural block group (PO group) were administered INB with ropivacaine at the end of the operation combined with PCA. To evaluate the analgesic effect, postoperative pain was assessed with the visual analogue scale (VAS) at rest and Prince Henry Pain Scale (PHPS) scale at 6, 12, 24, 48, and 72 hours after surgery.

At 6 h and 12 h post-surgery, the VAS at rest and PHPS scores in the PR group were significantly lower than those in the PO group. There were no significant differences in pain scores between two groups at 24, 48, and 72 hours post-surgery.

In patients undergoing VATS, preventive INB with ropivacaine provided a significantly better analgesic effect in the early postoperative period (at least through 12 h post-surgery) than did INB given at the end of surgery.


Ropivacaine;  Intercostal nerve block;  Analgesia


Objetivo: Comparar o efeito analgésico do bloqueio do nervo intercostal (BNI) com a ropivacaína quando administrado de forma preventiva ou no final da operação em pacientes submetidos à cirurgia torácica videoassistida (CTVA). Métodos: Um total de 50 pacientes submetidos a CTVA foram divididos aleatoriamente em dois grupos. Os pacientes do grupo de analgesia preventiva (grupo PR) receberam BNI com ropivacaína antes da manipulação intratorácica combinada com analgesia controlada pelo paciente (PCA). Os pacientes do grupo bloqueio pós-procedimento (grupo PO) receberam BNI com ropivacaína no final da operação combinada com ACP. Para avaliar o efeito analgésico, a dor pós-operatória foi avaliada com a escala visual analógica (EVA) em repouso e a escala Prince Henry Pain Scale (PHPS) às 6, 12, 24, 48 e 72 horas após a cirurgia. Resultados: Em 6 h e 12 h após a cirurgia, os escores da EVA em repouso e PHPS no grupo PR foram significativamente menores do que os do grupo PO. Não houve diferenças significativas nos escores de dor entre os dois grupos em 24, 48 e 72 horas após a cirurgia. Conclusão: Em pacientes submetidos a CTVA, BNI preventivo com ropivacaína proporcionou um efeito analgésico significativamente melhor no pós-operatório imediato (pelo menos até 12 h pós-cirurgia) do que BNI administrado no final da cirurgia.


Ropivacaína; Bloqueio do nervo intercostal; Analgesia


E.L. Grogan, D.R. Jones
VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes
Thorac Surg Clin, 18 (2008), pp. 249-258

A. D’Andrilli, M. Ibrahim, A.M. Ciccone, et al.
Intrapleural intercostal nerve block associated with mini-thoracotomy improves pain control after major lung resection
Eur J Cardiothorac Surg, 29 (2006), pp. 790-794

S. Takamori, S. Yoshida, A. Hayashi, et al.
Intraoperative intercostal nerve blockade for postthoracotomy pain
Ann Thorac Surg, 74 (2002), pp. 338-341

P.N. Wurnig, H. Lackner, C. Teiner, et al.
Is intercostal block for pain management in thoracic surgery more successful than epidural anaesthesia
Eur J Cardiothorac Surg, 21 (2002), pp. 1115-1119

R.G. Soto, E.S. Fu
Acute pain management for patients undergoing thoracotomy
Ann Thorac Surg, 75 (2003), pp. 1349-1357

A. Machino, M. Wakamatsu, T. Kaida, et al.
Postoperative pain management in video-assisted thoracic surgery using a continuous unilateral intercostal analgesia
Masui, 63 (2014), pp. 1319-1323

U. Zurawska, S. Parasuraman, S.Z. Goldhaber
Prevention of pulmonary embolism in general surgery patients
Circulation, 115 (2007), pp. e302-7

M.C. Grant, D. Yang, C.L. Wu, et al.
Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections: Results From a Systematic Review and Meta-analysis
Ann Surg, 265 (2017), pp. 68-79

H. Kehlet, D.W. Wilmore
Evidence-based surgical care and the evolution of fast-track surgery
Ann Surg, 248 (2008), pp. 189-198

T. Hernandez-Boussard, L.A. Graham, K. Desai, et al.
The Fifth Vital Sign: Postoperative Pain Predicts 30-day Readmissions and Subsequent Emergency Department Visits
Ann Surg, 266 (2017), pp. 516-524

D. Fletcher, V. Martinez
Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis
Br J Anaesth, 112 (2014), pp. 991-1004

J. Guay
The benefits of adding epidural analgesia to general anesthesia: a metaanalysis
J Anesth, 20 (2006), pp. 335-340

E.A. Ochroch, A. Gottschalk
Impact of acute pain and its management for thoracic surgical patients
Thorac Surg Clin, 15 (2005), pp. 105-121

D.A. Peura, L. Goldkind
Balancing the gastrointestinal benefits and risks of nonselective NSAIDs
Arthritis Res Ther, 7 Suppl 4 (2005), pp. S7-13

A. Vogt, D.S. Stieger, C. Theurillat, et al.
Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery
Br J Anaesth, 95 (2005), pp. 816-821

N.J. O’Keeffe, T.E. Healy
The role of new anesthetic agents
Pharmacol Ther, 84 (1999), pp. 233-248

Y. Ishikawa, T. Maehara, T. Nishii, et al.
Intrapleural analgesia using ropivacaine for postoperative pain relief after minimally invasive thoracoscopic surgery
Ann Thorac Cardiovasc Surg, 18 (2012), pp. 429-433

B.M. Graf, I. Abraham, N. Eberbach, et al.
Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties
Anesthesiology, 96 (2002), pp. 1427-1434

A.C. Santos, P.I. DeArmas
Systemic toxicity of levobupivacaine, bupivacaine, and ropivacaine during continuous intravenous infusion to nonpregnant and pregnant ewes
Anesthesiology, 95 (2001), pp. 1256-1264

A.M. Kaiser, A. Zollinger, D. De Lorenzi, et al.
Prospective, randomized comparison of extrapleural versus epidural analgesia for postthoracotomy pain
Ann Thorac Surg, 66 (1998), pp. 367-372

D. Simpson, M.P. Curran, V. Oldfield, et al.
Ropivacaine: a review of its use in regional anaesthesia and acute pain management
Drugs, 65 (2005), pp. 2675-2717

H. Behnke, F. Worthmann, J. Cornelissen, et al.
Plasma concentration of ropivacaine after intercostal blocks for video-assisted thoracic surgery
Br J Anaesth, 89 (2002), pp. 251-253

Y. Niiyama, T. Yotsuyanagi, M. Yamakage
Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia
J Plast Reconstr Aesthet Surg, 69 (2016), pp. 1445-1449

6107fa2aa9539542005d4462 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections