preliminary report Continuous Extrapleural Intercostal Nerve Block With Continuous Infusion of Lidocaine After Thoracotomy

ous infusion of1% lidocaine hydrochloride at a dose of 1 mg/kg/h. A posterior parietal pleural pocket was created and cannulated with a 16-g polyethylene catheter. Lidocaine was perfused over a 3-day period following surgery. Patients also had access to mor¬ phine sulfate via patient-controlled analgesia. Eigh¬ teen consecutive posterolateral thoracotomies (in 17 patients) performed during a 6-month period were reviewed. Serum lidocaine exceeded the toxic level of 5 ug/mL in only one patient, a 104.5-kg man who had a level of 5.9 ug/mL on postoperative day 2 but expe¬ rienced no clinical toxicity. Pain was evaluated by verbal analog scores (0=no pain and 10=worst pain), which averaged 3.02, 3.14, and 2.8 in the 3 days following surgery. Mean total daily MS doses were 24.3,37.75, and 34.32 mg (range, 0 to 94 mg). Sedation was scored on a 1 to 5 scale. Mean scores were 2.78, 2.56, and 2.6. No patient died or had a major respira¬ tory complication. Continuous EPIB with lidocaine appears to he a promising adjuvant technique in the management of postthoracotomy pain. Effectiveness needs to be confirmed in a prospective randomized study. (CHEST 1995; 108:1718-23)