Fiorelli, A., Izzo, A.C., Frongillo, E.M., Del Prete, A., Liguori, G., Di Costanzo, E., . . . Santini, M. (2016). Efficacy of wound analgesia for controlling post-thoracotomy pain: A randomized double-blind study. European Journal of Cardio-Thoracic Surgery, 49, 339–347.

To investigate the effectiveness of wound analgesia for pain in patients undergoing lung cancer resection

Patients were randomly allocated to receive either continuous surgical wound site infusion of bupivacaine or normal saline as a placebo control. All patients use PCA postoperatively. All patients received a standardized anesthetic management. After surgery, all had IV PCA of 5 mg bolus morphine followed by 1.2 mg per hour with a 5-10 minutes lockout for the first 48 hours postoperatively. Additional morphine or ketorolac was given if needed due to a pain score greater than 4, at 15 mg, every 6 to 8 hours. No oral pain medications were used. Cytokine levels were measured before surgery and at 6, 12, 24, 48, and 72 hours postoperatively.

• N = 55   
• AGE: Mean = 63 years
• MALES: 58%  
• FEMALES: 42%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Non-small cell lung cancer; 96% had lobectomy

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Denmark

PHASE OF CARE: Active anti-tumor treatment

Double-blind, placebo-controlled RCT

• VAS for pain
• Pulmonary function tests FVC% and FEV1%
• Analgesic requirement
• Blood samples for cytokine levels

Cytokines IL6, IL10, and TNF alpha were significantly lower in the wound analgesia group (p < 0.001). Pain scores were consistently lower in the wound analgesia group at all time points in the study at rest (p < 0.001) and after coughing (p = 0.01). Those in the wound analgesia group required less additional morphine (p = 0.03) or ketorolac (p = 0.01) compared to the placebo group. The wound analgesia group had faster recovery of FEV1 (p = 0.01) and FVC (p = 0.02). There were no adverse events associated with the analgesia.

Wound analgesia infusion was effective for postoperative pain control, reduction in cytokine levels, and faster recovery of pulmonary function after lung resection.

Small sample (< 100)

This study adds to a growing body of evidence showing effectiveness of wound analgesia for management of postoperative pain. Nurses can advocate for consideration of this type of approach for postoperative pain management in their patients.