Comparative Study of Continuous Intercostal Nerve Block and Epidural Anesthesia for Postoperative Analgesia in Thoracotomy
The main reasons for the less effective analgesia with continuous intercostal nerve block (CINB) are: 1) the anterior branch of the intercostal nerve and the traffic branches to the contralateral chest wall; the selection of an anterolateral incision cannot completely block pain transmission. 2) The parietal pleura may have incomplete local drug accumulation. Considering preoperative pleural adhesions, surgery might compromise the integrity of the parietal pleura or involve the selection of an anterolateral incision, patients should use continuous epidural anesthesia (CEA) for analgesia. In the South China National Defense Medical Journal in 2005, it was found that the side effects of CINB analgesia were significantly less than those of CEA. Due to serious complications from CEA, mainly stemming from respiratory inhibition—such as the blocking effect on intercostal muscles and intraoperative muscle relaxants affecting diaphragmatic movement—it hinders the recovery of pulmonary function. In this study, group A showed higher PCO2 indicators at 4-24 hours post-surgery compared to group B, indicating to some extent the suppression of early postoperative ventilatory function by CEA. Differences due to individual variations in sex and drug dosage lead to considerable differences in the incidence of respiratory inhibition reported from 0.9% [6J to 13.5% [’J]. Additionally, CEA can easily cause bilateral sympathetic block leading to bradycardia or hypotension and other hemodynamic changes, especially in elderly patients. Due to nerve dysfunction and decreased sympathetic nerve activity, these patients are more likely to experience significant fluctuations in heart rate and blood pressure. Although the incidence of these complications has declined in recent years due to improvements in CEA drugs, finding the balance between optimal drug dosage and analgesic effect for individual patients remains very challenging, unpredictable, and potentially life-threatening. Therefore, for elderly patients with poor heart and lung function, using CEA analgesia during the early postoperative period requires particularly close monitoring. Elderly patients receiving CINB analgesia can significantly reduce respiratory and circulatory complications, protect postoperative cardiopulmonary function, and alleviate the pressure of postoperative care. Compared to traditional methods, both CEA and CINB provide excellent analgesic effects that meet the requirements for thoracotomy postoperative analgesia. Given equal analgesic efficacy, CINB offers greater security.