A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management.
BACKGROUND
Thoracotomy is a surgical procedure associated with severe pain. Operative morbidity rates reduce by effective postoperative pain control. The aim of this study is to compare the effectiveness of the thoracic epidural blockade (TEB) and the paravertebral blockade (PVB) methods in relieving the pain caused by a thoracotomy incision.


METHODS
We studied 44 consecutive patients who underwent elective posterolateral thoracotomy. The patients were classed into two groups: TEB (n=19) and PVB (n=25). Patients in both the groups could self-control the infusion of bupivacaine infusion and diclofenac sodium. The groups were compared according to the parameters such as analgesic efficacy (VAS), respiratory function tests (forced expiratory volume in 1s (FEV(1)), peak expiratory flow rate (PEFR) and arterial blood gases), stress response (serum cortisol and glucose levels), adverse effects, necessity for additional analgesia, duration of catheter application procedure, mean hospital stay and postoperative follow-up. Results are analysed statistically by Mann-Whitney U, Wilcoxon, chi-square and Fisher's exact tests, and a p-value of <0.05 was accepted to be statistically significant.


RESULTS
There was no significant difference between the two groups with regard to age, gender, VAS, FEV(1), PEFR, serum cortisol and glucose levels, necessity for additional analgesia and hospital staying days. In contrast, adverse effects and duration of catheterisation were statistically significantly lower in group PVB (p=0.001 and p<0.001, respectively).


CONCLUSIONS
PVB catheterisation can be easily performed and placed in a short span perioperatively. Therefore, it might be the preferred method over TEB which has a high incidence of adverse effects and complication rates.
Gulbahar
Gultekin
G
Ankara Numune Teaching and Research Hospital, Division of Thoracic Surgery, Ankara, Turkey. mdgultekin@gmail.com
Kocer
Bulent
B
Muratli
Serife Nursel
SN
Yildirim
Erkan
E
Gulbahar
Ozlem
O
Dural
Koray
K
Sakinci
Unal
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001786:Blood Glucose / Q000378:metabolism; D002045:Bupivacaine / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D013908:Thoracotomy / Q000009:adverse effects*; D055815:Young Adult
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001786:Blood Glucose; D004008:Diclofenac; D006854:Hydrocortisone; D002045:Bupivacaine