Can analgesia with intercostal catheter be an alternative to epidural analgesia for thoracotomy? A prospective study

Aim: Thoracic epidural analgesia is known as the gold standard for a thoracotomy. An intercostal nerve block may be an alternative, but there are limited data in the literature about analgesia provided by intercostal catheters. This study was designed to compare the efficacy of thoracic epidural analgesia and analgesia provided by an intercostal nerve block in thoracotomy. Material and Methods: Patients undergoing open thoracotomy were included in the study and divided into two groups. In the intercostal catheter group, the surgeon placed the intercostal catheter into the intercostal space, and in the epidural catheter group, an anesthesiologist placed the epidural catheter at the end of the surgery. A blinded anesthesiologist recorded the postoperative pain follow-up using the visual analog scale (VAS) score at rest, during movement, and during coughing. Standard monitoring and anesthetic protocols were applied to all patients. Results: In total, 102 patients were included in this study. There was a significant difference between the groups in the VAS values at rest both at 12 and 24 hours (p:0,004). The VAS values during movement showed differences only at the 48th hour of follow-up. The VAS score for chest tube removal time showed no difference. Discussion: Postthoracotomy pain is one of the most challenging problems for thoracic anesthesiologists and surgeons. Epidural analgesia is the gold standard; however, further studies are needed to prove the effectiveness of alternative methods. The results of this study suggest that an intercostal nerve block with a catheter can be a good alternative to thoracic epidural analgesia.