Epidural versus paravertebral analgesia for pneumonectomy

Abstract

Thoracic epidural analgesia has widely been regarded as the gold standard for treatment of pain associated with thoracotomy and reduction in adverse events. However, a recent meta-analysis and systemic review article comparing the analgesic efficacy and side-effects of epidural versus paravertebral blockade for thoracotomy concluded that although the analgesia was comparable, paravertebral blockade had a better side-effect profile [1]. The aim of this study of pneumonectomy outcome was to examine UK anaesthetic practice, firstly to obtain the incidences of analgesic techniques used, and secondly to determine if there were any associations between the mode of analgesia and major complications. This multi-centre, prospective, observational cohort study invited data from all 35 UK thoracic surgical centers on pneumonectomies for lung cancer performed between 1 January and 31 December 2005 using a 50-field dataset. Major complications were defined as: death within 30 days of surgery; treated cardiac arrhythmia or hypotension; unplanned intensive care admission; further surgery and inotrope usage. The data centre received information for 312 patients from 24 centres distributed across the UK. The most common mode of analgesia was epidural (61%) followed by paravertebral blockade (31%). In stepwise logistic regression analysis, the use of epidural anaesthesia was found to be statistically significant for poor outcomes (p = 0.02). This study has shown that epidural blockade remains the commonest form of analgesia for pneumonectomy in the UK, and that epidural analgesia is associated with more major complications than paravertebral analgesia.