Analgesia in patients undergoing thoracotomy: epidural versus paravertebral technique. A randomized, double-blind, prospective study

Abstract

Background: Pain control after thoracotomy prevents postsurgical complications and improves respiratory function. The gold standard for post-thoracotomy analgesia is the epidural catheter. The aim of this study was to compare it with a new technique that involves placement of a catheter in the paravertebral space at the end of surgery under a surgeon's direct vision.

Methods: From November 2011 to June 2012, 52 patients were randomized into 2 groups depending on catheter placement: an epidural catheter for group A and a paravertebral catheter for group B. At 12, 24, 48, and 72 hours after surgery, the following parameters were recorded: (1) pain control using the patient's completion of a visual analog scale module, (2) respiratory function using forced expiratory volume in 1 second and ambient air saturation, and (3) blood cortisol values as an index of systemic reaction to pain.

Results: Statistically significant differences (P < .05) were found in favor of group B for both cough and rest pain control (P = .002 and .002, respectively) and respiratory function in terms of forced expiratory volume in 1 second and ambient air saturation levels (P = .023 and .001, respectively). No statistically significant differences were found in blood cortisol trends between the 2 groups (P > .05). Collateral effects such as vomiting, nausea, low pressure, or urinary retention were observed only in group A. No collateral effects were recorded in the paravertebral group.

Conclusions: According to our data, drugs administered through a paravertebral catheter are very effective. Moreover, it does not present contraindications to its positioning or collateral effects. More studies are necessary to confirm data we collected.

Keywords: 1; 11; 14; 5; EA; FEV1; PA; VAS; epidural anesthesia; forced expiratory volume in 1 second; paravertebral anesthesia; visual analog scale.