passages: 3791
passages: document
passages: Double-blind randomized evaluation of intercostal nerve blocks as an adjuvant to subarachnoid administered morphine for post-thoracotomy analgesia . BACKGROUND AND OBJECTIVES Thoracotomy is associated with pain and compromised pulmonary function . Intercostal nerve blocks ( INB ) and subarachnoid morphine ( SM ) act on different portions of the pain pathway . Each is effective for post-thoracotomy pain relief . The combination of these two modalities in relieving post-thoracotomy pain and improving postoperative pulmonary function has not been investigated . METHODS In a double-blind study , 20 patients undergoing lateral thoracotomy for lung resection were randomized to receive 0.5 mg SM preoperatively and INB with bupivacaine ( INB+ ) prior to wound closure or 0.5 mg SM with INB using saline ( INB- ) . Visual analog scale pain scores at rest , with cough , and with movement of the ipsilateral arm , forced expiratory volume in 1 second ( FEV1 ) , and forced vital capacity ( FVC ) were measured at 4 , 24 , 48 , and 72 hours after the operation . Opioid use was measured during the initial 24 hours after the operation . RESULTS At 4 hours , the INB+ group demonstrated better FEV1 ( 56.6 % vs. 40.4 % of baseline , P < .05 ) and FVC values ( 54.6 % vs. 39.6 % of baseline , P < .05 ) and less resting and cough pain ( P < .05 ) . However , FEV1 continued to decline in the INB+ group at 24 hours to lower than the INB- group although pain scores were similar beyond 4 hours . Opioid usage during the first 24 hours was similar ( INB- , 16.7 mg vs. INB+ , 13.2 mg , P = .7 ) . CONCLUSIONS Although postoperative INB provided modest improvements in pain and pulmonary function when used as an adjuvant to 0.5 mg SM for post-thoracotomy analgesia , the benefits were transient . The authors do not recommend adding INB for patients undergoing lateral thoracotomy who receive 0.5 mg SM .
entities: 3792
entities: Intervention_Other
entities: intercostal nerve blocks
entities: 3793
entities: Intervention_Pharmacological
entities: morphine
entities: 3794
entities: Intervention_Other
entities: Intercostal nerve blocks ( INB )
entities: 3795
entities: Intervention_Pharmacological
entities: subarachnoid morphine ( SM )
entities: 3796
entities: Intervention_Pharmacological
entities: SM
entities: 3797
entities: Intervention_Other
entities: INB with bupivacaine ( INB+ )
entities: 3798
entities: Intervention_Pharmacological
entities: SM
entities: 3799
entities: Intervention_Control
entities: INB using saline ( INB- )
entities: 3800
entities: Intervention_Other
entities: INB+
entities: 3801
entities: Intervention_Other
entities: INB+
entities: 3802
entities: Intervention_Control
entities: INB-
entities: 3803
entities: Intervention_Control
entities: INB-
entities: 3804
entities: Intervention_Other
entities: INB+
entities: 3805
entities: Intervention_Other
entities: INB
entities: 3806
entities: Intervention_Pharmacological
entities: SM
entities: 3807
entities: Intervention_Other
entities: INB
entities: 3808
entities: Intervention_Pharmacological
entities: SM
entities: 3809
entities: Outcome_Pain
entities: pain
entities: 3810
entities: Outcome_Pain
entities: post-thoracotomy pain
entities: 3811
entities: Outcome_Physical
entities: postoperative pulmonary function
entities: 3812
entities: Outcome_Physical
entities: Visual analog scale pain scores
entities: 3813
entities: Outcome_Physical
entities: with cough , and with movement of the ipsilateral arm , forced expiratory volume in 1 second ( FEV1 )
entities: 3814
entities: Outcome_Physical
entities: forced vital capacity ( FVC )
entities: 3815
entities: Outcome_Other
entities: Opioid use
entities: 3816
entities: Outcome_Physical
entities: FEV1
entities: 3817
entities: Outcome_Physical
entities: FVC
entities: 3818
entities: Outcome_Physical
entities: FEV1
entities: 3819
entities: Outcome_Pain
entities: pain scores
entities: 3820
entities: Outcome_Other
entities: Opioid usage