Study of Exparel Versus Epidural for Pain Control After Thoracotomy

Randomized Non-inferiority Trial of Continuous Thoracic Epidural Analgesia Versus Single Intercostal Nerve Block After Thoracotomy

Unilateral intercostal nerve blocks provide pain control as effectively as a continuous thoracic epidural, and will a lower incidence of side effects.

In this study we will study to see if a single set of unilateral intercostal nerve blocks provides pain control as effectively as a continuous thoracic epidural, and will a lower incidence of side effects. Although the anesthesiologists involved in providing care for patients having thoracotomy incisions at St. Mary's Hospital are experts at placing thoracic epidural catheters, this study will attempt to show that a less technically challenging procedure done by surgeons intra-operatively can provide comparable pain relief.

Inclusion Criteria:

• Age 18 years and older
• Undergoing thoracotomy (lobectomy, segmentectomy, wedge resection or pneumonectomy).

Exclusion Criteria:

• Planned chest wall resection or abdominal incision and/or gastroesophageal surgery;
• Current enrollment in another post-thoracotomy analgesic research protocol; pre-existing pain syndrome (such as fibromyalgia, complex regional pain syndrome or postherpetic neuralgia in a thoracic distribution);
• Daily opioid therapy;
• Current gabapentin or pregabalin therapy;
• Allergy to any study medication; coagulation or infectious issues that would preclude epidural catheter placement;
• Severe psychological disorders or inability to understand the study protocol; -Prisoners or other institutionalized individuals;
• Severe hepatic, renal or cardiovascular disorders.
• Women who are pregnant will not be included in this study.