Efficacy of Cryoanalgesia versus Bupivacaine as Two Methods of Intercostal Nerve Blockade on Post-Thoracotomy Pain Relief: A Human Prospective Randomized Clinical Trial

Abstract

Background: Pain following posterolateral thoracotomy, is recognized as a major cause of morbidity and mortality. Various methods have been used for the treatment of post-thoracotomy pain, however, the treatment of post-thoracotomy pain remains controversial. The aim of this study was to compare the efficacy of Bupivacaine versus Cryoanalgesia for local intercostal nerve blockade on post-thoracotomy pain relief. Methods: In a randomized clinical trial, eighty patients who were scheduled to undergo posterolateral thoracotomy were selected and classified, randomly, into two groups. Group A underwent intercostal nerve blockade with Bupivacaine every 8 hours after surgery for three days. In group B, two nerves upper and lower of incision level was freezed by Cryoprobe. Postoperative pain was assessed by 0-10 cm visual Analogue Scale (VAS) every 8 hours and then, after one hour, both groups were received intravenous morphine according to their needs. Results: Mean and standard deviation (Mean ± SD) of pain level were 4.70 ± 2.38 in group A and 4.87 ± 2.25 in group B. The t-test showed no statistically significant differences between two groups (t = 1.08, p = 0.28). Morphine consumption was 5.35 ± 3.17 mg in group A and 5.30 ± 3.20 mg in group B; Also there were no statistically significant differences between two groups (t = 1.25, p = 0.21). Conclusion: Cryoanalgesia and Bupivacaine showed equivalent analgesic effect on posterolateral thoracotomy pain reduction. We suggest cryoanalgesia as an easy-to-use technique, but for routine application, further studies with long-term follow up and more cases are recommended.
Keywords: cryoanalgesia, bupivacaine, blockade, postoperation pain, thoracotomy, posterolateral, intercostal nerves,
nerve block, analgesia.