Comparıson of On-Q Intercostal Elastomerıc Pump System and Intravenous Analgesıa Methods for Paın Management after Thoracotomy

Background: Thoracotomy has been defined as one of the most painful surgical procedures. Inadequate pain control increases morbidity, hospital costs, and hospital length of stay. Aim: We aimed to compare the results of continuous infusion of local anesthetics through an intercostal On-Q (ICOQ) elastomeric pump under the pleura or intravenous analgesia to manage post-thoracotomy pain. Methods: We performed a prospective comparative analysis of 149 consecutive patients who underwent anterolateral thoracotomy between January 2018 and October 2021. Postoperative pain management with a continuous infusion elastomeric pump providing local anesthetic into the intercostal area was compared with intravenous analgesia. Patients received either the ICOQ elastomeric pump system (n = 73) or intravenous analgesia (n = 76) for the first 48 postoperative hours. Visual Analog Scale (VAS) rescue patient-controlled analgesia morphine consumption, hemodynamic, and side effects were evaluated within 48 hours. Results: The VAS scores of the IV group at 1, 4, 12, 24, 36, and 48 hours were statistically significantly higher than the On-Q group. ( P = 0.028, P = 0.041, P = 0.011, P = 0.001, P = 0.021, P = 0.017, respectively postoperative complications occurred in 17 (23%) patients in the ICOQ group, and 34 (45%) patients in the IV group. There was no significant difference between the two groups in terms of postoperative complications except for nausea and vomiting. Conclusion: Continuous analgesia using the ICOQ is an effective analgesia method for postoperative pain control for thoracotomy procedures that reduces pain scores and additional opioid consumption.