A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery.
BACKGROUND
The aim of this prospective, randomized, blinded study was to compare analgesic efficacy of continuous paravertebral and epidural analgesia for post-thoracotomy pain.


METHODS
Forty-two ASA physical status II-III patients undergoing lung resection surgery were randomly allocated to receive post-thoracotomy analgesia with either a thoracic epidural (group EPI, n = 21) or paravertebral (group PVB, n = 21) infusion of 0.2% ropivacaine (infusion rate: 5-10 mL h-1). The degree of pain at rest and during coughing, haemodynamic variables and blood gas analysis were recorded every 12 h for the first 48 h.


RESULTS
The area under the curve of the visual analogue pain score during coughing over time was 192 (60-444) cm h-1 in group EPI and 228 (72-456) cm h-1 in group PVB (P = 0.29). Rescue morphine analgesia was required in four patients of group EPI (19%) and five patients of group PVB (23%) (P = 0.99). The PaO2/FiO2 ratio reduced significantly from baseline values in both groups without between-group differences. The median (range) percentage reduction of systolic arterial pressure from baseline was -9 (0 to -9)% in group PVB and -17 (0 to -38)% in group EPI (P = 0.02); while clinically relevant hypotension (systolic arterial pressure decrease >30% of baseline) was observed in four patients of group EPI only (19%) (P = 0.04). Patient satisfaction with the analgesia technique was 8.5 (8-9.8) cm in group EPI and 9 (7.5-10) cm in group PVB (P = 0.65).


CONCLUSIONS
Continuous thoracic paravertebral analgesia is as effective as epidural blockade in controlling post-thoracotomy pain, but is associated with less haemodynamic effects.
Casati
A
A
University of Parma, Department of Anaesthesiology and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy. acasati@ao.pr.it
Alessandrini
P
P
Nuzzi
M
M
Tosi
M
M
Iotti
E
E
Ampollini
L
L
Bobbio
A
A
Rossini
E
E
Fanelli
G
G
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure; D004311:Double-Blind Method; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy; D011446:Prospective Studies; D000077212:Ropivacaine; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine