J Thorac Cardiovasc Surg 2004;128:154-155
© 2004 The American Association for Thoracic Surgery
Improved pain control after cardiac surgery
Giuseppe Rescigno, MD,
Giannantonio Carnelos, MD
Cardiovascular Unit, Salus Hospital, Reggio Emilia, Italy
To the Editor:
We read with interest the article by Dowling and associates1 about improved pain control by means of intraoperative intercostal nerve block followed by postoperative continuous infusion of ropivacaine. We performed a similar study that will be published soon.2 We randomly assigned 47 patients to two groups. The study group (n = 23) was treated by soft-tissue infiltration with bupivacaine (10 mL 0.5% bupivacaine) followed by 36 hours of continuous infusion (bupivacaine 0.5% at 120 mL/24 h) through a small-diameter catheter positioned anteriorly to the sternum. In the control group (n = 24) the catheter was positioned as well but there was neither infiltration nor postoperative infusion. After the operation we assessed pain control by a visual analog scale at specific time points (extubation and 12, 24, and 36 hours). We also recorded the assisted ventilation time as well as the intravenous administrations of analgesic drugs. Blood gas analysis was performed at extubation and at 6, 12, and 24 postoperative hours. Unlike Dowling and associates' findings,1 we were unable to demonstrate any effectiveness of this treatment, even though the drug and its dosage were similar to those used in their study. However, the protocol of these authors consisted in a T1-T12 intercostal nerve block, whereas we performed a local soft-tissue infiltration. We therefore may speculate that the efficacy of Dowling and associates' treatment was related more to the intercostal nerve block than to the postoperative continuous infusion, which was common to both studies. An interesting second step of their study would be the comparison between the sole intercostal nerve block and this procedure followed by continuous anesthetic infusion. Regardless, we may conclude that these attempts to reduce postoperative pain are promising and deserve future developments.
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References
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- Dowling R, Thielmeier K, Ghaly A, Barber D, Boice T, Dine A. Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial. J Thorac Cardiovasc Surg. 2003;126:1271–1278[Abstract/Free Full Text]
- Magnano D, Montalbano R, Lamarra M, Ferri F, Lorini L, Clarizia S, et al. Uneffectiveness of local wound anesthesia to reduce postoperative pain after median sternotomy. J Card Surg. In press
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