RESPIRATION AND THE AIRWAY Analgesia and pulmonary function after lung surgery: is a single intercostal nerve block plus patient-controlled intravenous morphine as effective as patient-controlled epidural anaesthesia? A randomized non-inferiority clinical trial

Editor’s key points † Thoracic epidural analgesia is associated with rare but potentially serious complications. † In the setting of lung surgery single-shot intercostal block (ICB) offers an alternative modality of postoperative regional analgesia. † This study compared PCEA with single-shot ICB combined with PCA. ICB with PCA was not as effective as PCEA with respect to postoperative pain control and pulmonary function. † This study does not support the use of ICB rather than thoracic epidural analgesia for postoperative pain relieve in lung surgery. Background. Thoracic epidural anaesthesia (EDA) is regarded as the ‘gold standard’ for postoperative pain control and restoration of pulmonary function after lung surgery. Easier, less time-consuming, and, perhaps, safer is intercostal nerve block performed under direct vision by the surgeon before closure of the thoracotomy combined with postoperative i.v. patient-controlled analgesia with morphine. We hypothesized that this technique is as effective as thoracic EDA.