Thoracic Surgery

Pain. Give me Bupivacaine.


Give me Novacaine

Skeptik Reviewer: Dr. Ali Albargawi

Tell Me Jimmy
Ali Albargawi


Clinical Fellow, Senior Resident, Working Bee, New Dad, Jimmy the Bupivacaine Giver

Case: Your 65 year old female patient is requesting something for pain before her thoracotomy for lung cancer resection.  She saw a movie on Netflix about Bupivacaine and wondered if that’s something she could have.




Reference:Nosotti M, Rosso L, Tosi D, Palleschi A, Mendogni P, Righi I, Marenghi C, Santambrogio L. Preventive analgesia in thoracic surgery: controlled, randomized, double-blinded study.  Eur J Cardiothorac Surg. 2014 Dec 18. pii: ezu467. PMID: 25527168

Clinical Question: what is the efficacy of preoparative Dextromethorphan associated with Intercostal nerve Block (IB) using Levobupivacaine

  • Population: Thoracotomy patients who refuse or had contraindication to epidural anesthesia.
  • Intervention: PreOp Dextromethorphan with IB (PreOp or PostOp)
  • Comparison: Placebo
  • Outcome: cumulative morphine consumption within 1st two weeks PostPp


Author’s Conclusions: PreOp administration of Dextromethorphan with PreOp IB using Levobupivacaine can provide preventive analgesia decreasing analgesic administration during the early PostOp period.

Guideline: How to use an article evaluating surgical interventions

A.  Are the results valid?

  1. Did the trial ask a clearly focused question? YES
  2. Was the assignment of patients randomized? UNSURE
  3. Was randomization process was concealed? YES
  4. Were all patients who entered the trial accounted for at the end? YES
  5. Were all of the patients analyzed in the groups to which they were randomized? YES
  6. Was the follow up of subjects complete and long enough? YES
  7. Were patients, health workers, assessors “blind” to treatment? YES
  8. Were the groups similar at the start of the trial? YES
  9. Apart from the intervention, were the groups treated equally? YES

B.  What are the results?

  1. How large was the treatment effect?
  2. How precise are the results?
  3. Do you believe the results? YES


C.  Do the results apply to my patients?

  1. Were the study patients similar to my patients? YES
  2. Were all clinically important outcomes considered? YES
  3. Are the benefits worth the harms and costs? UNSURE


Key Results: early postop period vs post thoracotomy syndrome.


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