Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

Florian Ponholzer; Caecilia Ng; Herbert Maier; Hannes Dejaco; Andreas Schlager; Paolo Lucciarini; Dietmar Öfner; Florian Augustin

doi:10.3390/jcm10020372

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

J Clin Med. 2021 Jan 19;10(2):372. doi: 10.3390/jcm10020372.

Authors

Florian Ponholzer¹, Caecilia Ng¹, Herbert Maier¹, Hannes Dejaco², Andreas Schlager², Paolo Lucciarini¹, Dietmar Öfner¹, Florian Augustin¹

Affiliations

¹ Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria.
² Department of Anaesthesiology and Critical Care, Medical University of Innsbruck, 6020 Innsbruck, Austria.

Abstract

Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) affects patients' recovery, postoperative complications, and length of stay (LOS). Despite its relevance, there are no guidelines on optimal perioperative pain management. This study aims to analyse the effects of an additional intercostal catheter (ICC) in comparison to a single shot intraoperative intercostal nerve block (SSINB).

Methods: All patients receiving an anatomic VATS resection between June 2019 and May 2020 were analysed retrospectively. The ICC cohort included 51 patients, the SSINB cohort included 44 patients.

Results: There was no difference in age, gender, comorbidities, or duration of surgery between cohorts. Pain scores on the first postoperative day, after chest drain removal, and highest pain score measured did not differ between groups. The overall amount of opioids (morphine equivalent: 3.034 mg vs. 7.727 mg; p = 0.002) as well as the duration of opioid usage (0.59 days vs. 1.25 days; p = 0.005) was significantly less in the ICC cohort. There was no difference in chest drain duration, postoperative complications, and postoperative LOS.

Conclusions: Pain management with ICC reduces the amount of opioids and number of days with opioids patients require to achieve sufficient analgesia. In conclusion, ICC is an effective regional anaesthesia tool in postoperative pain management in minimally invasive thoracic surgery.

Keywords: VATS; intercostal catheter; lung cancer; minimally invasive; opioid; pain; postoperative pain control; regional anaesthesia; thoracic surgery.