Abstract
BACKGROUND:
Pain relief using regional neuroaxial blockade is standard care for patients undergoing major thoracic surgery. Thoracic epidural analgesia (TEA) provides effective postoperative analgesia but has unwanted side effects, including hypotension, urinary retention, nausea, and vomiting, and is highly operator dependent. Single-shot intercostal nerve and paravertebral blockade have not been widely used because of the short duration of action of most local anesthetics; however, the recent availability of liposomal bupivacaine (LipoB) offers the potential to provide prolonged blockade of intercostal nerves (72 to 96 hours). We hypothesized that a five-level unilateral posterior intercostal nerve block using LipoB would provide effective analgesia for patients undergoing thoracic surgery.
METHODS:
We identified patients who underwent lung resection using intraoperative LipoB posterior intercostal nerve blockade and retrospectively compared them with a group of patients who had TEA and who were matched for age, sex, type of surgery, and surgical approach. We analyzed perioperative morbidity, pain scores and narcotic requirements.
RESULTS:
There were 54 patients in each group. Mean hospital stay was 3.5 days and 4.5 days (p = 0.004) for LipoB group and TEA group, respectively. There were no significant differences in perioperative complications, postoperative pain scores, or in narcotic utilization between LipoB group and TEA group. No acute toxicity related to LipoB was observed.
CONCLUSIONS:
Posterior intercostal nerve blockade using LipoB is safe and provides effective analgesia for patients undergoing thoracic surgery. It may be considered as a suitable alternative to TEA.

Objective: To compare the efficacy and adverse effects of
using bronchial blockers (BBs) and double-lumen endobronchial
tubes (DLTs).
Design: Systematic review and meta-analysis of randomized
controlled trials (RCTs) comparing BBs and DLTs.
Setting: Hospital units undertaking thoracic surgery
Participants: Patients undergoing thoracic surgery requiring
lung isolation.
Interventions: BBs and DLTs.
Measurements and Main Results: A systematic literature
search was conducted for RCTs comparing BBs and DLTs
using Google Scholar, Ovid Medline, and Cochrane library
databases up to October 2013. Inclusion criteria were RCTs
comparing BBs and DLTs, intubation carried out by qualified
anesthesiologists or trainee specialists, outcome measures
relating to either efficacy or adverse effects. Studies that
were inaccessible in English were excluded. MantelHaenszel
fixed-effect meta-analysis of recurring outcome
measures was performed using RevMan 5 software. The
search produced 39 RCTs published between 1996 and 2013.
DLTs were quicker to place (mean difference: 51 seconds,
95% confidence intervals [CI] 8-94 seconds; p ¼ 0.02) and
less likely to be incorrectly positioned (odds ratio [OR] 2.70;
95% CI 1.18-6.18, p ¼ 0.02) than BBs. BBs were associated
with fewer patients having a postoperative sore throat (OR
0.39, 95% CI: 0.23-0.68, p ¼ 0.0009), less hoarseness (OR:
0.43,95%, CI 0.24-0.75, p ¼ 0.003), and fewer airway injuries
(OR 0.40, 95% CI 0.21-0.75, p ¼ 0.005) than DLTs.
Conclusion: While BBs are associated with a lower incidence
of airway injury and a lower severity of injury, DLTs
can be placed quicker and more reliably.
& 2015 Elsevier Inc. All rights reserved.
KEY WORDS: bronchial blocker, double-lumen endobronchial
tube, lung isolation, one-lung ventilation, thoracic surgery,
efficacy, adverse effects