Opioid-sparing effect of modified intercostal nerve block during single-port thoracoscopic lobectomy: A randomised controlled trial
Authors: De-Wen Shi
Er-Wei Gu
Xue-Sheng Liu
Xin-Qi Cheng
Guang-Hong Xu
Xiao-Ci Huang
Mao-Yun Zhang
Qi Fang
Journal: European journal of anaesthesiology (2020)
Discipline: CLINICAL MEDICINE
Keywords: Peripheral local anaesthetic blockade; multimodal postoperative analgesia; video-assisted thoracic surgery; intercostal nerve block; opioid-sparing effect
Affiliations: From the Department of Anaesthesiology, First Affiliated Hospital, Anhui Medical University and Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China., Xin-qi Cheng and Mao-yun Zhang contributed equally to this work.

Abstract:  Background: Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect. Objective: This prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy. Design: This was a randomised controlled study. Setting: The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020. Patients: Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled. Intervention: Patients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg-1 remifentanil, it was then infused at 0.2 to 0.5 μg kg-1 min-1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values. Main outcome measures: The primary outcome was intra-operative remifentanil consumption. Results: Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03). Conclusion: We have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects. Trial registration: http://www.chictr.org.cn, ChiCTR2000029337. 

Retracted: Yes

PubPeer comments:
 Concerns about data in this paper discussed here: http: www.cardiobrief.org cvctcardiobrief ?p=20327 ,