P-207 * EPIDURAL VERSUS PARAVERTEBRAL ANALGESIA IN THORACOTOMY PATIENTS: A RANDOMIZED, PROSPECTIVE STUDY

Abstract

Objectives: Pain control after thoracotomies prevents complications and improves respiratory function. The gold standard is epidural catheter (EP). In 2013 we published early results comparing EP with a technique involving placement of a catheter in the paravertebral space. To improve the value of the study we now present an update of the study with a wider patient population in order to improve its value. Methods: From November 2011 to July 2013, 71 patients were randomized into two groups depending on site of catheter placement: epidural for group A and paravertebral for Group B. The catheter (Contiplex Tully Set, BBraun) was placed by the same surgeons tunnelling the parietal pleura and entering the paravertebral space before thoracotomy closure. At 6, 12, 24, 48 and 72 hours after surgery, the following parameters were recorded: (a) pain control; (b) respiratory function using forced expiratory volume in one second (FEV1) and ambient air saturation and (c) blood cortisol values as systemic reactions to pain. Records were analyzed with the Mann-Withney or Student's tests. Results: Statistically significant differences (P < 0.05) have been found in favour of group B concerning both cough and rest pain control (P = 0.0021 and 0.002 respectively) and respiratory function in terms of FEV1 and ambient air saturation (P = 0.0231 and 0.001). No significant differences have been found in blood cortisol trends (P > 0.05). No complications after placement were recorded in both groups. Collateral effects such as vomit, nausea, low pressure or urinary retention have been observed in 28 of 34 patients belonging to group A. Conclusions: Results of this update were consistent with our previous study. Extended data strengthen the evidence that drugs administered through a catheter in the paravertebral space are very effective. This technique does not present collateral effects. Moreover there are no contraindications to its positioning.