Ricerc@Sapienza

Postoperative residual pleural space is a well-known complication contributing to prolong hospitalization in patients underwent lung resection. Many comorbidities may favour the occurrence of residual pleural space. After a thoracotomy access, patients experience postoperative pain while taking breaths at rest or at movement. Post-operative pain affects post-surgery recovery, increasing the risk of pulmonary complications. The use of bupivacaine through an epipleural catheter to block the phrenic nerve has yet successfully described to achieve pain control and to resolve residual air space persistence through hemidiaphragm temporary paralysis. We would select a number of patients with risk factors for residual air space after major thoracic surgery. They would be assigned to have phrenic nerve infiltration at diaphragm level during surgery by positioning a perineural catheter with its tip in intrapleural space, receiving infusion of 10mls of 0.25% bupivacaine. We would like to demonstrate that intra-operative phrenic nerve infiltration should be performed as a well-tolerated procedure to obtain at the same time not only an early expansion of the residual lung, facilitated by mechanical function of hemidiaphragm paralysis, but also a good pain control in the early postoperative period. This could allow the patient to mobilize more quickly after surgery and to obtain an early respiratory recovery, reducing hospitalization and complications after lung surgery. This medical intervention would produce significant health benefits at a reasonable cost respect to the existing procedures to achieve the same results.