Intercostal block vs. epidural analgesia in thoracoscopic lung cancer surgery: a randomized trial

To explore the best strategy for combatting pain after thoracoscopic lobectomy for cancer.

We conducted a randomized-controlled trial to compare two major analgesic procedures-intercostal nerve block and epidural analgesia-in patients scheduled to undergo thoracoscopic lobectomy and lymphadenectomy. High-dose oral celecoxib was started 3 h after operation in intercostal nerve block group or after withdrawal of epidural analgesia in epidural analgesia group. The primary endpoint was postoperative pain and adverse events, and the secondary endpoint was the length of the analgesic procedure and physiological function on postoperative day 1.

This study was closed before accumulating the necessary sample size. We eventually analyzed 21 patients undergoing intercostal nerve block and 22 patients undergoing epidural analgesia. Although the incidence of postoperative adverse events and postoperative complications was comparable between the groups, the incidence of procedure-related troubles was significantly higher in the epidural analgesia group than in the intercostal nerve block group. The length of the analgesic procedure was significantly shorter in the intercostal nerve block group than in the epidural analgesic group. The postoperative pain during postoperative days 0-7, as evaluated by a visual analog scale, was not significantly different between the groups. Likewise, postoperative physiological function, as evaluated by vital capacity and walking distance, was not significantly different between the groups.

Although our limited sample size compromised our ability to draw definitive conclusions, intercostal nerve block followed by high-dose oral celecoxib seems to be an option for patients undergoing thoracoscopic lobectomy for lung cancer.