Efficacy of Thoracic Epidural Analgesia With or Without Intercostal Nerve Cryoanalgesia for Postthoracotomy Pain

Background. We evaluated effects of thoracic epidural analgesia combined with intercostal nerve cryoanalgesia or epidural analgesia alone on acute and long-term pain after posterolateral thoracotomy. Methods. Forty-two elective thoracotomy patients were randomly assigned to two groups, epidural combined with cryoanalgesia or epidural alone. A thoracic epidural catheter was inserted before induction of anesthesia. At the end of the operation, cryoanalgesia was performed to 3 intercostals nerves: 1 at the level of the incision, 1 caudal, and 1 cranial. Cryoanalgesia was blinded to the investigating anesthetists and patients. To avoid impingement of intercostal nerves, chest closure in all patients was performed using intracostal sutures through drilled holes in adjacent ribs. In the postanesthesia care unit, epidural infusion of ropivacaine (1 mg/mL) with fentanyl (5 mu g/mL) was started and continued 3 days. Thereafter, pain was treated with oral strong or weak opioids combined with nonsteroidal antiinflammatory drugs or acetaminophen. Pain was assessed with the verbal pain scale or visual analog scale. Patients visited a local pain clinic at 8 weeks and at 6 months postoperatively. Results. The cryoanalgesia group had more neuropathic-type pain compared with the epidural-alone group 8 weeks after operation (p < 0.05). The cryoanalgesia group had also more pain on normal daily activities 8 weeks after the operation (p < 0.05). After 6 months, there were no statistically significant differences between groups. Conclusions. Intercostal cryoanalgesia seems to increase the incidence of long-term pain after thoracotomy. (Ann Thorac Surg 2011;91:869-73) (C) 2011 by The Society of Thoracic Surgeons