Place of the paravertebral block in post-operative analgesia in thoracic surgery

Abstract

The thoracic epidural analgesia (TEA) remains the standard gold for analgesic support in thoracic surgery, there is an interesting alternative to epidural analgesia, which is the paravertebral block (PVB). The aim in our study was to assess the value of performing a PVB in the management of postoperative pain in thoracic surgery compared to TEA. Methods: 80 patients were randomized to receive either epidural analgesia (n = 38, 10 cc bupivacaine 0.5% + 10 ϒ Sufentanyl then 10 cc Bupivacain 0.1% + 10 ϒ Sufentanyl via a PCA device) or PVB analgesia loss of resistance technique (n = 40, 10 cc bupivacaine 0.5% + 10 ϒ Sufentanyl via a PCA device). All patients received standard general anesthesia. The peri-operative parameters studied include standard measurement, EVA scale at rest and mobilization, use of morphinics. Results: there is a significant difference between the two groups and the incidents of puncture were significantly more important for the APDT group. The postoperative pain assessment by EVA did not show a significant difference between TEA and PVB Conclusion: the comparison of PVB to TPDA did not find significant difference in the efficacy of analgesia and the side effects. The BPV could be proposed as a first intention for postoperative analgesia in thoracic surgery.