Comparison between systemic analgesia, continuous wound catheter analgesia and continuous thoracic paravertebral block:  a randomised, controlled trial of postthoracotomy pain management.
BACKGROUND
Thoracotomy is the surgical procedure that creates the greatest demand for postoperative analgesia.


OBJECTIVE
We aimed to compare the efficacy of systemic analgesia, continuous wound catheter (CWC) analgesia and thoracic paravertebral block (TPVB) for pain management after thoracotomy, assessed by Visual Analogue Scale (VAS) pain score and morphine consumption.


METHODS
Prospective, randomised study.


METHODS
University teaching hospital. Inclusions from April 2007 to February 2010.


METHODS
153 adult patients scheduled for pulmonary surgery.


METHODS
All three groups received systemic analgesia with paracetamol and morphine (patient-controlled analgesia, PCA). The PCA group received systemic analgesia only. The TPVB group underwent insertion of a paravertebral catheter and the CWC group underwent CWC catheter insertion at the end of the intervention.


METHODS
Pain score at rest as assessed by VAS.


RESULTS
One hundred and fifty-three patients were included, of whom 140 were included in the final analysis (50 PCA, 44 TPVB, 46 CWC). Baseline and surgical characteristics were comparable in the three groups. VAS scores were statistically different between the TPVB and PCA groups at rest (at 0, 1, 3, 6 h; P < 0.0026) and after coughing (0, 1, 3, 6, 12 h; P < 0.003). In recovery room care, titrated morphine doses were significantly lower (P = 0.00001) in the TPVB group than in the other two. Morphine consumption was statistically lower in the TPVB group than in the PCA group at 24 h (P = 0.0036). There was no difference between CWC and PCA groups in terms of VAS scores or morphine consumption. No signs of toxicity or local complications were observed.


CONCLUSIONS
Our results support the efficacy of TPVB for pain management after thoracotomy, at rest and after coughing. These results confirm the preference for TPVB over epidural analgesia in postthoracotomy pain care. CWC failed to decrease pain and morphine consumption and performed no better than placebo.
Département d'Anesthésie Réanimation, CHU du Bocage, Dijon, France. simon.fortier@orange.fr
Simon
S
Fortier
Halim A
HA
Hanna
Alain
A
Bernard
Claude
C
Girard
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D057785:Catheters; D003371:Cough / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D013904:Thoracic Vertebrae; D013908:Thoracotomy / Q000379:methods*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen; D009020:Morphine