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Thoracic paravertebral block after thoracotomy: comparison of three different approaches

Hospital General Universitario Gregorio Marañon, Street Doctor Esquerdo 46, Madrid 28007, Spain

Received 31 May 2008; received in revised form 29 December 2008; accepted 12 January 2009.

^_* Corresponding author. Tel.: +34 91 5868367; fax: +34 91 5868367. (Email: ngaruttimartinez{at}yahoo.es).

Background: Thoracic paravertebral block (TPVB) is a regional block technique increasingly used for the early management of post-thoracotomy pain. We compare three different postoperative analgesic approaches based on TPVB: anesthetist, anesthetist plus surgeon, and surgeon. Materials and methods: We randomized 54 patients undergoing elective thoracotomy to three different postoperative analgesia groups: paravertebral percutaneous catheter (PVA group), paravertebral percutaneous catheter plus incisional (subcutaneous) catheter (PVA + Inc), and paravertebral catheter under direct vision (PVS group). During early postoperative 48 h, we measured pain intensity, intravenous morphine afforded by the patient-controlled analgesia pump, and the spirometric test. Results: There were no statistically significant differences among the collected preoperative data. No significant differences were observed on postoperative spirometric values. Analgesic quality was better in PVA + Inc group at 12 and 24 postoperative hours. In this group, intravenous morphine use to improve analgesia was significantly lower from 8 h until 48 h postoperative. Conclusions: Association of thoracic paravertebral block to continuous infusion of a local anesthetic in the surgical incision area affords a better pain relief than paravertebral block alone (introduced by the surgeon or the anesthetist).

Key Words: Post-thoracotomy pain • Thoracic paravertebral block • Thoracotomy • Incisional analgesia • Spirometry