Intrapleural Nebulization of Bupivacaine to Reduce the Postoperative Pain and Improve the Pulmonary Function After Video-Assisted Thoracic Surgery: A Randomized Prospective Double-Blinded Controlled Clinical Trial

Document Type : Original Article

Authors

1 Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University.

2 Department Cardiothoracic Surgery, Faculty of Medicine, Assiut University.

Abstract

Significant pain can occur after video-assisted thoracic surgery (VATS), which affects recovery and optimization of pulmonary function at discharge. Different pain control regimens have been used. Here, we try intrapleural nebulization of Bupivacaine.
Patients and Methods: The study recruited 50 patients scheduled for lobectomy of either sex and of ASA class I-III. Participants were gathered into two groups: The Bupivacaine group (Group B), in which patients had intrapleural nebulization of Bupivacaine 0.5% (10ml) in a syringe labeled for nebulization via Aero-neb device (aregeon) before skin closure. The control group (Group C) in which patients received intravenous analgesia in the form of paracetamol 1 gram and ketorolac 30mg. Postoperative pain was measured using the NRS score at rest and during cough at the following time (2, 4, 8, 12, and 24 hours after surgery). Rescue analgesia was given whenever the NRS score was ≥ 4 at rest with nalbuphine (0.1 mg/kg).frequency and total nalbuphine consumption during the first 24 hours postoperatively were recorded. A Volumetric incentive spirometer was used to record patients' maximal inspired volume generated (Vmiv). Postoperative complications during the first 24 hours were reported.
Results: The duration needed to require pain medications was significantly longer in the bupivacaine group versus control group[485.76 (414.3 – 557.23) min] versus [129.6 (110.59 – 148,61) min] respectively (P < 0.001). Also, patients who had opioid analgesia as rescue analgesia in the first 24 hours were significantly fewer in the bupivacaine group(P < 0.001).
Conclusion: Intrapleural Bupivacaine nebulization is effective in controlling pain following uniportal video-assisted thoracic surgery.

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