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Updated: Apr 19, 2026

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Preventive analgesia in thoracic surgery: controlled, randomized, double-blinded study.

Mario Nosotti1, Lorenzo Rosso1, Davide Tosi1

  • 1Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|December 21, 2014
PubMed
Summary

Preoperative dextromethorphan with intercostal nerve block reduced early postoperative morphine use in thoracotomy patients. This preventive analgesia approach did not impact long-term function or post-thoracotomy syndrome.

Keywords:
AnalgesiaPreventiveThoracic surgery

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Thoracic Surgery

Background:

  • Preventive analgesia aims to reduce pain and central sensitization by administering treatment before surgery.
  • Randomized studies on preventive analgesia efficacy are debated.
  • Epidural analgesia is often preferred for thoracotomy but may not be suitable for all patients.

Purpose of the Study:

  • To evaluate the analgesic efficacy of preoperative dextromethorphan combined with intercostal nerve block (IB) using levobupivacaine.
  • To assess this combination in thoracotomy patients who cannot receive epidural analgesia.
  • To compare cumulative morphine consumption (CMC) in different treatment groups.

Main Methods:

  • A four-arm, double-blinded, randomized placebo-controlled trial involving 400 thoracotomy patients.
  • Patients received either dextromethorphan or placebo, combined with either preoperative or postoperative intercostal block (IB).
  • The primary endpoint was cumulative morphine consumption within 14 days post-surgery.

Main Results:

  • Group A (preoperative dextromethorphan and preoperative IB) showed the lowest mean CMC (111.4 mg), significantly lower than other groups (P = 0.0001).
  • No significant differences were found in demographic data, surgical details, postoperative function, or post-thoracotomy syndrome prevalence.
  • Female gender was identified as a predictor for post-thoracotomy syndrome.

Conclusions:

  • Preoperative dextromethorphan with preoperative intercostal block provides effective preventive analgesia, reducing early postoperative pain medication needs.
  • This combined approach is a viable alternative for patients unsuitable for epidural analgesia.
  • The study did not demonstrate an effect of this preventive analgesia strategy on long-term functional outcomes or the incidence of post-thoracotomy syndrome.