Tehran University Medical Journal

---

Background: Pain control after posterolateral thoracotomy is very important for adequate respiration and to reduce pulmonary complications. Narcotic-induced respiratory depression requires different intercostal nerve block procedures with local anesthesia, such as bupivacaine, through an extrapleural catheter, paravertebral catheter and intrapleural injection in order to control pain and reduce narcotics consumption. The aim of this study is to determine the efficacy of bupivacain versus normal saline (N/S) in pain control after thoracotomy.
Methods: In a single-blind clinical trial, forty patients were divided into two groups of 20 patients each. Group 1 (G.1) received a single dose (10 ml) of bupivacaine 0.5%, followed by continuous infusion of N/S (0.1 ml/kg/h) four hours after surgery. Group 2 (G.2) received a single dose (10 ml) of bupivacaine 0.5%, followed by a continuous infusion of bupivacaine (0.1 ml/kg/h) four hours after surgery. Postoperative pain was assessed every four hours for 48 hours by linear visual analog scale (VAS). If VAS > 5, then pethidine was injected at a dosage of 1 mg/kg/IM. VAS ≤ 3 was considered pain control.
Results: TThe mean VAS at 8, 12, 16, 20 and 24 hours after surgery in G.1 was 7.6, 5.5, 6.6, 5.5 and 5.7, respectively, and in G.2 was 3.4, 3.7, 2.8, 2.1 and 1.9, respectively. There were significant differences between the two groups (for 12 hours P<0.001 and for other time points P=0.0001). During the 4-24 hour period after surgery, pain control in G.1 was 5% and in G.2 was 81%. The mean VAS at 28, 32, 36, 40, 44, and 48 hours after surgery in G.1 was 5.2, 5, 5.3, 4.4, 5.1, and 4.8, respectively, and in G.2 was 1.6, 1.8, 1.5, 1.6, 1.5 and 1.4, respectively, with a significant difference between the two groups (P<0.0001). In the first 24 hours, the mean of pethidine injection in G.1 was 3.7 and in G.2 was 0.6 (P<0.0001). In the second 24 hours, the mean pethidine injection in G.1 was 2.2 and in G.2 there was no need for pethidine (p<0.0001).
Conclusion: Continuous extrapleural infusion of bupivacaine is effective in pain control and decreasing demand for narcotics after thoracotomy.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Standard thoracotomy necessitates division of thoracic large muscles leading to pain and impaired respiratory movements muscle sparing postero-lateral thoracotomy has been suggested as an alternative to reduce the aforementioned effect. The aim of this study was to compare muscle saving posterolateral thoracotomy with standard thoracotomy.
Methods: This study was a clinical trial. All patients who were candidates for elective thoracotomy were included and divided into two groups of muscle saving thoracotomy and standard thoracotomy randomly. Required time for opening and closing the chest, amount of prescribed narcotics, shoulder movements (flexion, extension, abduction and internal rotation), pulmonary function (FVC, FEV1, VC), development of seroma, and duration of hospitalization were assessed. Shoulder movements and pulmonary function were measured immediately before operation and 7 days later while pain measured in 1^st and 7^th post-operative days.
Results: 60 patients (42 males) entered the study and there were no significant differences regarding age and sex distribution between two groups (p>0.05). Mean duration of opening the chest in muscle saving thoracotomy was significantly longer than standard procedure while the duration of closing the chest wall was significantly shorter in muscle saving thoracotomy (p<0.05). FVC and range of motion of the shoulder were higher and post-operative pain was lesser in muscle saving thoraocotomy than standard thoracotomy (p<0.05). There were no significant differences regarding prescribed narcotics and duration of hospital stay (p>0.05). Seroma developed in 13% (n=4) of muscle saving group.
Conclusion: Muscle saving thoracotomy can be used as an appropriate alternative for standard postero-lateral thoracotomy in elective thoracic operations.