Intraoperative haemodynamic stability and stress response to surgery in patients undergoing thoracotomy: comparison between ultrasound-assisted thoracic paravertebral and epidural block

Abstract

Objectives and aim Thoracotomy is a procedure usually associated with severe postoperative pain. This study aimed to evaluate intraoperative haemodynamics and stress response to thoracotomy in patients receiving thoracic epidural or thoracic paravertebral block. Patients and methods Sixty patients undergoing elective thoracotomy were randomly allocated into two equal groups: the thoracic paravertebral analgesia (TPVA) group, which received ultrasound-assisted thoracic paravertebral catheter, and the thoracic epidural analgesia (TEA) group, which received ultrasound-assisted thoracic epidural catheter. The primary outcome was the measuring of stress response to surgery using plasma cortisol level. The secondary outcomes included intraoperative haemodynamic parameters, visual analogue pain score and postoperative complications. Results Heart rate showed significantly lower values in the TEA group compared with the TPVA group. The mean arterial blood pressure showed significantly lower values in the TEA group compared with the TPVA group. In both groups, there was a significant increase in plasma cortisol level after surgical stress compared with basal values. Moreover, there were significantly lower values in the TPVA group compared with the TEA group at 2 h after surgical incision, 2 h postoperatively and 24 h postoperatively. Visual analogue pain score was noncomparable in both groups at all measurement timepoints. As regards complications, group TPVA had less complications compared with group TEA. Conclusion Thoracic paravertebral block is an effective analgesic technique showing greater haemodynamic stability and less stress response to surgery compared with epidural analgesia in patients undergoing thoracotomy.