A randomized controlled trial of @entity1341 through intracostal catheters for XXXX management after thoracotomy.

@entity1 @entity227 @entity174 @entity1341 @entity158 @entity1286 @entity282
BACKGROUND: Optimal management of @entity158 after thoracotomy can be challenging. Continuous infusion of local anesthetic into the incision may help reduce the amount of narcotics required to control @entity282 . To address this issue, we performed a randomized, double-blinded, controlled trial of infusion of @entity1341 versus placebo through intercostal and subcutaneous catheters after thoracotomy. METHODS: From April 2006 to June 2007, 124 @entity1 had intercostal catheters placed at thoracotomy and connected to continuous infusion @entity158 pumps. Each @entity1 had catheters placed in the intercostal space near the head of the rib and subcutaneously beneath the incision; both were connected to an infusion pump through a Y connector. @entity1 were randomly assigned to receive placebo (normal saline solution) or 0.25% @entity1341 as a 4 cc per hour infusion for 100 hours after thoracotomy. All personnel caring for the @entity1 were blinded to the content of the infusion. @entity227 scores, and oral @entity1286 equivalent usage was recorded for each @entity1 . In addition to the infusion catheters, all @entity1 had epidural analgesia that remained in place until postoperative day 3. RESULTS: There were 60 @entity1 in the @entity1341 arm and 64 in the placebo group. Overall mean age was 64.7 years and 65 (52.4%) were @entity1 . Mean body mass index was 28.8 kg/m(2). There were no statistical differences in any demographic parameter except that there were more @entity1 in the placebo group. Pulmonary resection was performed in 100 patients, an antireflux procedure in 16, and other miscellaneous procedures in 8. There was no statistical difference in the @entity1286 equivalent usage between the two groups. There was also no difference between the average daily @entity158 scores between the two groups. Length of stay was not significantly different between groups: mean (SD) of 6.2 (3.4) and 6.7 (5.0) for placebo and @entity1341 , respectively (p = 0.51). There was no operative mortality, and complications occurred in 28% of @entity1 (placebo group, 25%; @entity1341 group, 32%; p = 0.41). CONCLUSIONS: This randomized, double-blinded, controlled trial demonstrated that the infusion of local anesthetic into the subcutaneous area and around the rib @entity174 site in addition to epidural analgesia did not reduce the amount of narcotic usage after a thoracotomy, nor did it affect visual analog @entity158 scores. @entity158 control with intercostal catheters infusing local anesthetics did not produce a measurable @entity158 relief beyond that provided by epidural analgesia.
