A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management


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Gulbahara G., Kocer B., Muratli S. N. , Yildirim E., GÜLBAHAR Ö. , Dural K., ...More

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, vol.37, no.2, pp.467-472, 2010 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 37 Issue: 2
  • Publication Date: 2010
  • Doi Number: 10.1016/j.ejcts.2009.05.057
  • Title of Journal : EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
  • Page Numbers: pp.467-472
  • Keywords: Paravertebral blockade, Epidural blockade, Post-thoracotomy pain, Analgesia, Respiratory function tests, Metabolic stress response, INTERCOSTAL NERVE BLOCK, YOUNG INFANTS, THORACOTOMY, ANALGESIA, BUPIVACAINE, SURGERY, RESPONSES, INFUSION, RELIEF

Abstract

Background: Thoracotomy is a surgical procedure associated with severe pain. Operative morbidity rates reduce by effective postoperative pain control. The aim of this study is to compare the effectiveness of the thoracic epidural blockade (TEB) and the paravertebral blockade (PVB) methods in relieving the pain caused by a thoracotomy incision. Materials and methods: We studied 44 consecutive patients who underwent elective posterolateral thoracotomy. The patients were classed into two groups: TEB (n = 19) and PVB (n = 25). Patients in both the groups could self-control the infusion of bupivacaine infusion and diclofenac sodium. The groups were compared according to the parameters such as analgesic efficacy (VAS), respiratory function tests (forced expiratory volume in 1 s (FEV(1)), peak expiratory flow rate (PEFR) and arterial blood gases), stress response (serum cortisol and glucose levels), adverse effects, necessity for additional analgesia, duration of catheter application procedure, mean hospital stay and postoperative follow-up. Results are analysed statistically by Mann-Whitney U, Wilcoxon, chi-square and Fisher's exact tests, and a p-value of <0.05 was accepted to be statistically significant. Results: There was no significant difference between the two groups with regard to age, gender, VAS, FEV(1), PEFR, serum cortisol and glucose levels, necessity for additional analgesia and hospital staying days. In contrast, adverse effects and duration of catheterisation were statistically significantly lower in group PVB (p = 0.001 and p < 0.001, respectively). Conclusion: PVB catheterisation can be easily performed and placed in a short span perioperatively. Therefore, it might be the preferred method over TEB which has a high incidence of adverse effects and complication rates. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V All rights reserved.