Continuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications

Scand J Thorac Cardiovasc Surg. 1992;26(3):219-23. doi: 10.3109/14017439209099081.


To evaluate the effects of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary complications, a randomized, double-blind, placebo-controlled study was conducted on 80 patients undergoing elective thoracotomy for pulmonary (n = 47) or oesophageal (n = 33) procedures. In patients who received continuous bupivacaine infusion, the requirement for intramuscular opiate and rectal diclofenac was less, the score on a visual linear analogue pain scale lower and recovery of pulmonary function more rapid than in saline-infused controls. Postoperative pulmonary complications occurred in 35% of the saline group, but only 10% of the patients with bupivacaine infusion (p < 0.01). In patients with chronic obstructive airways disease (COAD), the incidence of postoperative pulmonary complications was 54.5% in the saline group and only 4.5% in the bupivacaine group (p < 0.01). Among the patients without COAD there was no significant intergroup difference in such complications. We conclude that continuous extrapleural intercostal nerve block is effective for post-thoracotomy analgesia and reduces pulmonary complications of thoracotomy in patients with COAD.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Analgesia / methods*
  • Bupivacaine / administration & dosage
  • Bupivacaine / therapeutic use*
  • Cough / prevention & control
  • Double-Blind Method
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Intercostal Nerves*
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Nerve Block / methods*
  • Pain, Postoperative / prevention & control
  • Peak Expiratory Flow Rate / physiology
  • Placebos
  • Pulmonary Atelectasis / prevention & control
  • Respiratory Mechanics / physiology
  • Thoracotomy* / adverse effects
  • Vital Capacity / physiology


  • Placebos
  • Bupivacaine