Opioid-sparing effect of modified intercostal nerve block during single-port thoracoscopic lobectomy: A randomised controlled trial

xloma.fota13 shared this article with you from Inoreader Opioid-sparing effect of modified intercostal nerve block during single-port thoracoscopic lobectomy: A randomised controlled trial Via European Journal of Anaesthesiology (EJA) - Published Ahead-of-Print BACKGROUND Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect. OBJECTIVE This prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy. DESIGN This was a randomised controlled study. SETTING The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020. PATIENTS Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled. INTERVENTION Patients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg−1 remifentanil, it was then infused at 0.2 to 0.5 μg kg−1 min−1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values. MAIN OUTCOME MEASURES The primary outcome was intra-operative remifentanil consumption. RESULTS Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03). CONCLUSION We have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects. TRIAL REGISTRATION http://www.chictr.org.cn, ChiCTR2000029337. Correspondence to Guang-hong Xu, Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China Tel: +86 0551 62922344; fax: +86 0551 62923704; e-mail: xuguanghong2004@163.com © 2020 European Society of Anaesthesiology View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.