Please use this identifier to cite or link to this item: https://doi.org/10.1186/s13019-021-01590-z
Title: Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study
Authors: Tan, Jian Wei 
Mohamed, Jameelah Sheik 
Tam, John Kit Chung 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Surgery
Cardiovascular System & Cardiology
Uniportal video-assisted thoracoscopic surgery (UVATS)
Postoperative recovery after thoracic surgery
Subpleural analgesia
Intercostal catheter
ON-Q pain relief system
CONTINUOUS EPIDURAL BLOCK
THORACIC PARAVERTEBRAL BLOCK
POSTOPERATIVE PAIN
NERVE BLOCK
CONTINUOUS-INFUSION
REGIONAL ANALGESIA
MUSCLE FLAP
EFFICACY
MANAGEMENT
LOBECTOMY
Issue Date: 31-Jul-2021
Publisher: BMC
Citation: Tan, Jian Wei, Mohamed, Jameelah Sheik, Tam, John Kit Chung (2021-07-31). Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study. JOURNAL OF CARDIOTHORACIC SURGERY 16 (1). ScholarBank@NUS Repository. https://doi.org/10.1186/s13019-021-01590-z
Abstract: Background: Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods: In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results: No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions: Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.
Source Title: JOURNAL OF CARDIOTHORACIC SURGERY
URI: https://scholarbank.nus.edu.sg/handle/10635/234727
ISSN: 1749-8090
DOI: 10.1186/s13019-021-01590-z
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