Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study

Background. Post-thoracotomy pain causes severe impairment of the respiratory function, Epidural analgesia is effective in the treatment of post-thoracotomy pain but may give rise to significant side-effects, Other low-risk and cost-effective analgesic treatments are therefore required. Methods. Thirty male patients who had undergone pulmonary Iobectomy entered a prospective, randomized trial to evaluate the efficacy of ketorolac tromethamine (Group 2) and extrapleural intercostal nerve block (Group 3) with intermittent low-dose bupivacaine, Objective and subjective assessment was carried out at 8, 16, 24 and 48 hours postoperatively. Results. There were no significant differences between Groups 1 (control group) and 2, Vital capacity was significantly lower in Group 3 (p<0.05) than in Group 1 after 16 hours, Forced Vital Capacity was significantly higher in Group 2 than in Group 3 after 16 and 24 hours (p<0.05), Peak expiratory Bow was also significantly better in Group 2 than in Group 3 after 16 hours (p<0.05). On-demand opioid consumption was significantly lower in Group 2 (p<0.001) and Group 3 (p<0.05), No side-effects were observed. Conclusions. Ketorolac tromethamine was effective in the treatment of post-thoracotomy pain, Extrapleural intercostal nerve block allowed a significant reduction in the consumption of opioids, These analgesic techniques could be useful as low-risk, cost-effective and reproducible treatments when more effective techniques, such as epidural analgesia, are contraindicated. RI International Surgery, ICS/D-3993-2011