Post-thoracotomy pain: three different analgesic modalities

Abstract

Background Pain following chest surgery is often underestimated and under treated which may lead to pulmonary dysfunction, prolonged stay, higher cost, potential development of chronic pain, and decreased patient satisfaction. Purpose The aim of this article is to compare thoracic paravertebral versus epidural thoracic block in the control of post-thoracotomy pain. Patients and methods Ninety patients subjected to thoracic surgery were enrolled in this study. They were randomly divided into three equal groups (30 patients each). In the control group (C group) we used intravenous analgesia (fentanyl). In both the thoracic epidural group (TEP group) and the thoracic paravertebral group (TPV group), bupivacaine (0.25%) in a dose of 0.5 mg/kg supplemented with fentanyl 1 μg/kg was used for perioperative analgesia. Assessment included the visual analogue scale for pain, number of patients who needed postoperative analgesia, and the total analgesic dose. Also pulmonary functions represented by forced vital capacity and forced expiratory volume in 1 s were recorded as baseline and at 24 and 48 h postoperatively. Results Visual analogue scale for pain was significantly lower in the TPV group compared with the other two groups, and at the same time it was lower in the TEP group compared with the control group. TEP analgesia was associated with significant hypotension compared with the other two groups. The number of patients who needed postoperative analgesia was lower in the TPV group than the other groups. Respiratory functions represented by forced vital capacity and forced expiratory volume in 1 s were better in TEP and TPV groups in comparison with the control group. Conclusion Thoracic paravertebral block (TPV) provides a higher quality control of postoperative pain than thoracic epidural (TEP) and systemic opioids.