Modified continuous intercostal nerve block for postoperative analgesia after uniportal thoracoscopic surgery.

Abstract

Background: Effective postoperative pain control is essential for recovery after surgery. This study aimed to evaluate the safety and efficacy of a modified continuous intercostal nerve block (MCINB) compared to conventional intravenous analgesia pump (IAP) for pain management following uniportal thoracoscopic lung resection.

Methods: We retrospectively analyzed patients who underwent uniportal thoracoscopic lung resection at our center between January 2020 and December 2023. Patients were divided into two groups based on the actual analgesia method used postoperatively: MCINB and IAP. The MCINB technique involved placing a multi-orifice catheter in the intercostal space under thoracoscopic guidance, with continuous infusion of local anesthetic. We compared postoperative numeric rating scale (NRS) pain scores at rest and during coughing, patient satisfaction with pain management, frequency of rescue analgesic use, analgesic-related side effects, catheter-related complications, length of hospital stay, and total medical costs.

Results: Among the 458 included patients, 196 received MCINB, and 262 received IAP. Linear mixed-effects model analysis showed that NRS pain scores at rest and during coughing were significantly lower in the MCINB group over the postoperative period (p < 0.001), with post hoc comparisons revealing no significant difference immediately after surgery and on the day of discharge (p > 0.05). At other time points, the median NRS scores in the MCINB group remained within the mild pain range. Patient satisfaction with pain management was significantly higher in the MCINB group than in the IAP group (90.3% vs. 65.6%, p < 0.001). Additionally, the MCINB group had a shorter hospital stay, lower total medical costs, reduced rescue analgesic use, and fewer analgesic-related side effects (p < 0.001). The incidence of intercostal catheter dislodgement and blockage was 1% (2/196) each, with no severe catheter-related complications reported.

Conclusion: MCINB appears to be a safe and effective option for early postoperative pain management after uniportal thoracoscopic surgery.