Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial.

Michał Borys,Agata Hanych,Mirosław Czuczwar

doi:10.3390/jcm9030793

Michał Borys, Agata Hanych + Show 1 more

Open Access

https://doi.org/10.3390/jcm9030793

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Abstract

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies.

Highlights

Even with recent advances in pain management, moderate to severe postoperative pain still affects many patients after open-chest surgeries or thoracotomies [1]
Because three groups were used in the study, we decided to randomize 120 patients. This single-center study was conducted in a thoracic surgery department of a teaching hospital
The results of this study confirm the effectiveness of Paravertebral block (PVB) in alleviating acute postoperative pain in patients undergoing posterolateral thoracotomy

Summary

Introduction

Even with recent advances in pain management, moderate to severe postoperative pain still affects many patients after open-chest surgeries or thoracotomies [1]. Severe pain is a risk factor for post-thoracotomy pain syndrome (PTPS). The combination of systemic analgesics with regional anesthesia techniques is the most preferred pain management approach in patients undergoing thoracotomies [4]. Among the different regional analgesia techniques, thoracic epidural analgesia (TEA) is most commonly performed by anesthesiologists [5,6]. Regional anesthesia techniques are advantageous to systemic analgesia during the perioperative period after thoracic surgery, alternative approaches are used because of failed blocks, lack of patient consent, and contraindications for this procedure [8,9]

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