title: Continuous infusion is superior to bolus doses with thoracic paravertebral blocks after thoracotomies.
abstract: OBJECTIVE
  This study was designed to determine whether a continuous thoracic paravertebral infusion of bupivacaine (continuous TPVI) offers a higher quality of analgesia than a bolus regimen after thoracotomy.
  
  
  METHODS
  A prospective and randomized study.
  
  
  METHODS
  It was conducted by an anesthesiology and pain clinic department in a university hospital.
  
  
  METHODS
  Thirty patients were included in this study.
  
  
  METHODS
  As postoperative analgesia, the patients received either 20 mL of 0.375% bupivacaine every 6 hours (n = 15; bolus group), or a loading dose of 15 mL of 0.375% bupivacaine, plus an infusion of 5 mL of 0.25% bupivacaine every hour (n = 15; infusion group).
  
  
  RESULTS
  Pain intensity was assessed at rest and on movement (coughing) at 0, 1, 4, 10, 20, and 48 hours by means of the visual analog scale. The need for additional rescue analgesia, bupivacaine plasma concentration in the infusion group, blockade level (pinprick), and vital signs were also recorded. There were no significant differences regarding the additional rescue analgesia, vital signs, and pinprick level. However, the pain scores were significantly higher in the bolus group at rest and on movement (p < 0.01). The bupivacaine plasma concentration was low with a Cmax of 1.841 +/- 0.20 micrograms/mL at 15 hours. No systemic toxicity or other side effects were seen.
  
  
  CONCLUSIONS
  Results suggest that continuous TPVI provides better pain control than the bolus regimen after this kind of surgery.
authors.affiliation: Anesthesiology and Pain Clinic Department, Hospital universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Català
authors.forename: J I
authors.initials: JI
authors.lastname: Casas
authors.forename: M C
authors.initials: MC
authors.lastname: Unzueta
authors.forename: X
authors.initials: X
authors.lastname: Diaz
authors.forename: L
authors.initials: L
authors.lastname: Aliaga
authors.forename: J M
authors.initials: JM
authors.lastname: Villar Landeira
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D013908:Thoracotomy
chemical_list: D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine