Paravertebral block with ropivacaine 0.5% versus systemic analgesia for pain relief after thoracotomy.
OBJECTIVE
Paravertebral block in combination to intravenous analgesics could be an alternative to epidural analgesia for postoperative pain control after thoracotomy, but it has been scarcely evaluated so far. We thus assessed the efficacy of paravertebral block using a continuous infusion of ropivacaine in a multimodal analgesic approach.


METHODS
Forty patients were randomized to receive ketoprofen, paracetamol, and patient-controlled-analgesia (PCA) with intravenous morphine (control group) or the same treatment with a continuous 48-hour infusion of ropivacaine 0.5% (0.1 mL/kg(-1)/h(-1)) in a thoracic paravertebral catheter (thoracic paravertebral block [TPVB] group). Visual analog scale (VAS) at rest and when coughing, morphine consumption, and side effects were recorded during the first 48 hours after surgery. Venous blood was sampled at 24 and 48 hours for ropivacaine plasma concentration measurements.


RESULTS
Mean VAS scores at rest and when coughing were significantly decreased in the TPBV group (p < 0.005). Despite a decrease in the morphine-titrated dose given in the postanesthesia care unit, cumulated morphine consumption was not significantly different between the two groups (51 +/- 29 mg and 57 +/- 24 mg in the TPVB and control groups, respectively). Side effects (nausea, vomiting, urinary retention) were less frequent in the TPBV group (30% vs 75%; p < 0.005). Plasma ropivacaine concentrations remained below the toxic threshold.


CONCLUSIONS
Continuous paravertebral ropivacaine 0.5% infusion improves pain control after thoracic surgery using a multimodal analgesic approach.
Marret
Emmanuel
E
Department of Anesthesiology and Critical Care, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. emmanuel.marret@tnn.ap-hop-paris.fr
Bazelly
Bernard
B
Taylor
Guillaume
G
Lembert
Nadège
N
Deleuze
Arnaud
A
Mazoit
Jean-Xavier
JX
Bonnet
Francis J
FJ
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007660:Ketoprofen / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D000077212:Ropivacaine; D013908:Thoracotomy / Q000009:adverse effects*
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D009020:Morphine; D000077212:Ropivacaine; D007660:Ketoprofen