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Article

Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial

by
Silvia González-Santos
1,
Borja Mugabure
1,
Manuel Granell
2,3,*,
Borja Aguinagalde
4,
Iker J. López
4,
Ainhoa Aginaga
1,
Inmaculada Zubelzu
1,
Haritz Iraeta
1,
Jon Zabaleta
4,
Jose Miguel Izquierdo
4,
Nuria González-Jorrín
1,
Cristina Sarasqueta
5 and
Alejandro Herreros-Pomares
6,7
1
Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain
2
Department of Anesthesiology, Postoperative Care and Pain Management, Hospital General Universitario de València, 46014 Valencia, Spain
3
Department of Surgery, Universitat de València, 46010 Valencia, Spain
4
Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain
5
Department of Clinical Epidemiology, Donostia University Hospital, ISS Bioguipuzcoa, 20014 San Sebastián, Spain
6
Department of Biotechnology, Universitat Politècnica de València, 46022 Valencia, Spain
7
Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(7), 1972; https://doi.org/10.3390/jcm13071972
Submission received: 14 February 2024 / Revised: 6 March 2024 / Accepted: 25 March 2024 / Published: 28 March 2024
(This article belongs to the Special Issue Current Trends and Future Challenges in Thoracic Anesthesia)
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Abstract

Background: Lung resection using video-assisted thoracoscopic surgery (VATS) improves surgical accuracy and postoperative recovery. Unfortunately, moderate-to-severe acute postoperative pain is still inherent to the procedure, and a technique of choice has not been established for the appropriate control of pain. In this study, we aimed to compare the efficacy and safety of intrathecal morphine (ITM) with that of intercostal levobupivacaine (ICL). Methods: We conducted a single-center, prospective, randomized, observer-blinded, controlled trial among 181 adult patients undergoing VATS (ISRCTN12771155). Participants were randomized to receive ITM or ICL. Primary outcomes were the intensity of pain, assessed by a numeric rating scale (NRS) over the first 48 h after surgery, and the amount of intravenous morphine used. Secondary outcomes included the incidence of adverse effects, length of hospital stay, mortality, and chronic post-surgical pain at 6 and 12 months after surgery. Results: There are no statistically significant differences between ITM and ICL groups in pain intensity and evolution at rest. In cough-related pain, differences in pain trajectories over time are observed. Upon admission to the PACU, cough-related pain was higher in the ITM group, but the trend reversed after 6 h. There are no significant differences in adverse effects. The rate of chronic pain was low and did not differ significantly between groups. Conclusions: ITM can be considered an adequate and satisfactory regional technique for the control of acute postoperative pain in VATS, compatible with the multimodal rehabilitation and early discharge protocols used in these types of surgeries.
Keywords: video-assisted thoracoscopic surgery; intrathecal morphine; intercostal levobupivacaine video-assisted thoracoscopic surgery; intrathecal morphine; intercostal levobupivacaine
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MDPI and ACS Style

González-Santos, S.; Mugabure, B.; Granell, M.; Aguinagalde, B.; López, I.J.; Aginaga, A.; Zubelzu, I.; Iraeta, H.; Zabaleta, J.; Izquierdo, J.M.; et al. Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial. J. Clin. Med. 2024, 13, 1972. https://doi.org/10.3390/jcm13071972

AMA Style

González-Santos S, Mugabure B, Granell M, Aguinagalde B, López IJ, Aginaga A, Zubelzu I, Iraeta H, Zabaleta J, Izquierdo JM, et al. Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial. Journal of Clinical Medicine. 2024; 13(7):1972. https://doi.org/10.3390/jcm13071972

Chicago/Turabian Style

González-Santos, Silvia, Borja Mugabure, Manuel Granell, Borja Aguinagalde, Iker J. López, Ainhoa Aginaga, Inmaculada Zubelzu, Haritz Iraeta, Jon Zabaleta, Jose Miguel Izquierdo, and et al. 2024. "Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial" Journal of Clinical Medicine 13, no. 7: 1972. https://doi.org/10.3390/jcm13071972

APA Style

González-Santos, S., Mugabure, B., Granell, M., Aguinagalde, B., López, I. J., Aginaga, A., Zubelzu, I., Iraeta, H., Zabaleta, J., Izquierdo, J. M., González-Jorrín, N., Sarasqueta, C., & Herreros-Pomares, A. (2024). Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial. Journal of Clinical Medicine, 13(7), 1972. https://doi.org/10.3390/jcm13071972

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