Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

Abstract

In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy. Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group). Standard general anesthesia was administered to all. Following anesthesia, postoperative analgesia of levobupivacaine 0.1% and morphine 0.1 mg mL-1 was administered via catheter. Patient-controlled analgesia (PCA) regime with tramadol was initiated, and amounts of local anesthetics and tramadol demanded and delivered within the first 24 hours were recorded. Visual analog scale (VAS) pain score, sedation score, side effects, and vital signs (blood pressure, heart rate, and respiratory rate) were assessed by an observer blinded to patient data at 1, 2, 3, 4, 6, 12, and 24 hours. Differences in PCA bolus demands and deliveries were not statistically significant between the PV group (26.8±1.3 and 33.1±4.5) and the ED group (25.1±3.5 and 32.5±4.3). Neither were differences in VAS scores statistically significant (p=0.3). Rates of sedation among the PV group were lower than those of the ED group at 1 hour (p=0.001). Five patients in the ED (%28) group experienced hypotension (p=0.02). Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg mL-1 may be an alternative form of pain relief following thoracotomy.