Prospective, Comparative Study of the On-Q® PainBuster® Postoperative Pain Relief System and Thoracic Epidural Analgesia After Thoracic Surgery

Objective: Pain after thoracotomy is associated with intense discomfort leading to impaired pulmonary function. Design: Prospective, non-randomized trial from April 2009 to September 2011. Setting: Department of Thoracic Surgery, single-center. Participants: Thoracic surgical patients. Interventions: Comparison of thoracic epidural analgesia (TEA) with the On-Q (R) PainBuster (R) system after thoracotomy. Measurements and Main Results: The TEA group (n = 30) received TEA with continuous 0.2% ropivacaine at 4 mL-to-8 mL/h, whereas Painbuster (R) patients (n = 32) received 0.75% ropivacaine at 5 mL/h until postoperative day 4 (POD4). Basic and on-demand analgesia were identical in both groups. Pain was measured daily on a numeric analog scale from 0 (no pain) to 10 (worst pain) at rest and at exercise. There were no significant differences regarding demographic and preoperative data between the groups, but PainBuster (R) patients had a slightly lower relative forced expiratory volume in 1 second (FEV1) (71 +/- 20% versus 86 +/- 21%; p = 0.01). Most common surgical procedures were lobectomies (38.8%) and atypical resections (28.3%) via anterolateral thoracotomy. Most common primary diagnoses were lung cancer (48.3%) and tumor of unknown origin (30%). At POD1, median postoperative pain at rest was 2.1 (1; 2.8) in the TEA group and 2 (1.5; 3.8; p = 0.62) in the PainBuster (R) group. At exercise, median pain was 4.3 (3.5; 3.8) in the TEA group compared to 5.0 (4.0; 6.5; p = 0.07). Until POD 5 there were decreases in pain at rest and exercise but without significant differences between the groups. Conclusions: Sufficient analgesia after thoracotomy can be achieved with the intercostal PainBuster (R) system in patients, who cannot receive TEA. (C) 2014 Elsevier Inc. All rights reserved.