Continuous paravertebral extrapleural infusion for post-thoracotomy pain management.
BACKGROUND
Continuous thoracic epidural analgesia is considered by many the gold standard for post-thoracotomy pain control but is associated with its own complications. In this study we compare continuous paravertebral extrapleural to epidural infusion for post-thoracotomy pain control.


METHODS
In a prospective fashion, 50 patients were randomized to receive either paravertebral or epidural infusion for post-thoracotomy pain control. The anesthesia department placed epidurals, and the operative surgeon placed unilateral paravertebral catheters. Patients were evaluated for analgesic efficacy and postoperative complications.


RESULTS
We found that both methods of analgesia provide adequate postoperative pain control. Epidural infusion demonstrated an improved efficacy early in the postoperative course but provided statistically similar analgesia to paravertebral by postoperative day 2. Neither group demonstrated a greater number of pain-related complications. Narcotic-induced complications such as pruritus, nausea/vomiting, and postural hypotension/mental status changes/respiratory depression were seen with statistically similar frequency in both epidural and paravertebral arms. Urinary retention, however, was noted to be significantly more frequent in patients with epidural catheters. Drug toxicity was not observed with either epidural or paravertebral infusion.


CONCLUSIONS
We recommend continuous paravertebral infusion as an improved method of post-thoracotomy analgesia that can be placed and managed by the surgeon.
Bimston
D N
DN
Department of Surgery, Evanston Hospital, Ill, USA.
McGee
J P
JP
Liptay
M J
MJ
Fry
W A
WA
D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D002404:Catheterization / Q000379:methods; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010994:Pleura; D011013:Pneumonectomy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D013908:Thoracotomy; D016055:Urinary Retention / Q000139:chemically induced; D014797:Vital Capacity
D000779:Anesthetics, Local; D009294:Narcotics; D005283:Fentanyl; D002045:Bupivacaine