Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

Abstract

Objectives: In this randomized, controlled, blinded study, the effects of thoracic
paravertebral analgesia were compared with those of epidural analgesia on postoperative pain, hemodynamics and respiration rate after thoracotomy.
Methods: The patients, scheduled for elective open-lung surgery, were included in the study. Before the surgery eighteen patients had thoracic epidural cathether (ED group) and 17 patients had an ultrasound-guided paravertebral cathether (PV group) inserted. Standard general anesthesia was administered to all of the patients. At the end of the anaesthesia, all patients received levobupivacaine 0.1% with morphine 0.1 mg ml-1 via catheters for postoperative analgesia. Patient controled analgesia(PCA) regime with tramadol was applied. The amount of local anaesthetics and tramadol used within the first 24 hours (delivery+demand) were recorded. The VAS pain score, sedation score, side effects and vital signs(blood pressure, heart rate and respiratory rate) were assessed by a blinded observer at 1, 2, 3, 4, 6, 12 and 24 hours postoperatively.
Results: The numbers of PCA boluses delivered and attempts were not statistically significant in Group PV (26.8 ± 1.3 and 33.1 ± 4.5) those Group ED (25.1 ± 3.5 and 32.5 ± 4.3. VAS scores were not statistically different between the PV group and ED groups (p=0.3).
Sedation in PV group was lower than those in ED group at 1. hours (p=0.001). Five patients in ED group experienced hypotension(p=0.02).
Conclusion: Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg ml-1 may be an altenative for the pain relief after thoracotomy.