title: A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy.
abstract: BACKGROUND
  Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven.
  
  
  METHODS
  The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication.
  
  
  RESULTS
  The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1-3.8; P=0.02) by stepwise logistic regression analysis.
  
  
  CONCLUSIONS
  An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity.
authors.affiliation: Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: E S
authors.initials: ES
authors.lastname: Powell
authors.forename: D
authors.initials: D
authors.lastname: Cook
authors.forename: A C
authors.initials: AC
authors.lastname: Pearce
authors.forename: P
authors.initials: P
authors.lastname: Davies
authors.forename: G M R
authors.initials: GM
authors.lastname: Bowler
authors.forename: B
authors.initials: B
authors.lastname: Naidu
authors.forename: F
authors.initials: F
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods; D011013:Pneumonectomy; D011183:Postoperative Complications; D016896:Treatment Outcome