Abstract
ObjectiveThe most recent systematic review and meta-analysis comparing the analgesic efficacy and side effects of paravertebral and epidural blockade for thoracotomy was published in 2006. Nine well-designed randomized trials with controversial results have been published since then. The present report constitutes an updated meta-analysis of this issue.Summary of BackgroundThoracotomy is a major surgical procedure and is associated with severe postoperative pain. Epidural analgesia is the gold standard for post-thoracotomy pain management, but has its limitations and contraindications, and paravertebral blockade is increasingly popular. However, it has not been decided whether the analgesic effect of the two methods is comparable, or whether paravertebral blockade leads to a lower incidence of adverse side effects after thoracotomy.MethodsTwo reviewers independently searched the databases PubMed, EMBASE, and the Cochrane Library (last performed on 1 February, 2013) for reports of studies comparing post-thoracotomy epidural analgesia and paravertebral blockade. The same individuals independently extracted data from the appropriate studies.ResultEighteen trials involving 777 patients were included in the current analysis. There was no significant difference in pain scores between paravertebral blockade and epidural analgesia at 4–8, 24, 48 hours, and the rates of pulmonary complications and morphine usage during the first 24 hours were also similar. However, paravertebral blockade was better than epidural analgesia in reducing the incidence of urinary retention (p<0.0001), nausea and vomiting (p = 0.01), hypotension (p<0.00001), and rates of failed block were lower in the paravertebral blockade group (p = 0.01).ConclusionsThis meta-analysis showed that PVB can provide comparable pain relief to traditional EPI, and may have a better side-effect profile for pain relief after thoracic surgery. Further high-powered randomized trials are to need to determine whether PVB truly offers any advantages over EPI.
Highlights
Thoracotomy, the surgical incision of the pleural cavity or chest wall, induces severe postoperative pain [1]
Paravertebral blockade was better than epidural analgesia in reducing the incidence of urinary retention (p,0.0001), nausea and vomiting (p = 0.01), hypotension (p,0.00001), and rates of failed block were lower in the paravertebral blockade group (p = 0.01). This meta-analysis showed that PVB can provide comparable pain relief to traditional EPI, and may have a better side-effect profile for pain relief after thoracic surgery
Further high-powered randomized trials are to need to determine whether PVB truly offers any advantages over EPI
Summary
Thoracotomy, the surgical incision of the pleural cavity or chest wall, induces severe postoperative pain [1]. The postoperative pain can lead to dreadful respiratory disorders including respiratory failure and other complications [2]. Epidural analgesia is clearly effective for managing postoperative pain after thoracotomy, it still has limitations and contraindications. The failure rate of epidural analgesia has been reported to be as high as 12% [7]. Epidural analgesia carries the risk for severe complications such as epidural abscess and spinal hematoma [7]. Because the analgesic effects of paravertebral blockade (PVB) are comparable to epidural analgesia (EPI), PVB may avoid the risks of EPI such as hypotension and urinary retention [8], and catheterization for PVB can be placed under direct vision during the surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
