A prospective, randomized comparison of continuous epidural and paravertebral analgesia in thoracic surgery

Abstract

Background and Goal of Study: The aim of this study was to compare analgesic efficacy and side effects of continuous thoracic paravertebral (TPVB) and epidural blocks (TEA) after thoracotomy. There after the addition of sufentanil to levobupivacaine was evaluated in the TPVB groups. Materials and Methods: Following the Ethics Committee approval and patients informed consents, 60 patients undergoing lateral thoracotomy were randomly divided into 3 groups: group A received a TPVB with levobupivacaine 0.5% (20 ml) in bolus and 0.25% in continuous infusion (5ml/h); group B received a TPVB with sufentanil 30 mug (1ml) and levobupivacaine 0.375% (19ml) in bolus and sufentanil 1 mug/ml plus levobupivacaine 0.125% in continuous infusion (5ml/h); group C received a TEA with sufentanil 30 mug (1ml) and levobupivacaine 0.375% (19 ml) in bolus and sufentanil 1 mug/ml plus levobupivacaine 0.125% in continuous infusion (5ml/h). TPVB was performed after induction of general anaesthesia, in lateral decubitus, at the T5-T6-T7 levels. At T7 level a like-epidural catheter was placed. In C group epidural catheter was placed before anaesthesia at the T5-T7 levels. Pain was assessed within 72 h by visual analogue score at rest (VASr) and on coughing (VASm). Supplemental analgesic requirement, complications, hemodynamic and respiratory parameters were registered. Statistical analysis was performed by variance and chi-square test. Results and Discussion: The distribution of pain scores was significantly different between the three groups. Group C had significantly lower VAS pain scores both at rest and on coughing (mean values under 1 and under 2 respectively) than group A and B (p < 0.01). The VASr score for the group A ranged from 0 to 2, whereas for the group B from 0 to 1.2; the VASm score for the group A ranged from 0.6 to 2.8, whereas for the group B from 0 to 2.5. Analgesic rescue was significantly higher in the TPVB groups (p < 0.05). No hemodynamic or respiratory complications occurred in the three groups. Our results showed a lower pain scores with TEA than TPVB, however TPVB represents a valid alternative to thoracic epidural block and may offer a better side-effect profile. The addition of sufentanil was very efficacious but the mechanism of action is debated. Conclusion(s): We concluded that TPVB can provide a complete analgesia, comparable to the one obtained by TEA. TPVB is technically easy, safe and very comfortable when performed in general anaesthesia. The addition of sufentanil allows a reduction in local anaesthetic dosages and provides a better analgesia.