title: Combined paravertebral and intrathecal vs thoracic epidural analgesia for post-thoracotomy pain relief.
abstract: BACKGROUND
  Although thoracic epidural analgesia (TEA) is considered the gold standard for post-thoracotomy pain relief, thoracic paravertebral block (PVB) and intrathecal opioid (ITO) administration have also been shown to be efficacious. We hypothesized that the combination of PVB and ITO provides analgesia comparable with that of TEA.
  
  
  METHODS
  After local ethics committee approval, 84 consecutive patients undergoing open thoracic procedures were randomized to the TEA (ropivacaine 0.2%+sufentanil) or the PVB (ropivacaine 0.5%)+ITO (sufentanil+morphine) group. The primary endpoints were pain intensities at rest and during coughing/movement at 1, 2, 4, 8, 12, 24, 48, and 72 h after operation assessed by visual analogue scale (VAS) score. Data were analysed by multivariate analysis (anova; P<0.05).
  
  
  RESULTS
  Patient and surgical characteristics were comparable between the groups. The mean and maximal VAS scores were lower in the TEA (n=43) than in the PVB+ITO group (n=37) at several time points at rest (P<0.026) and during coughing/movement (P<0.021). However, in the PVB+ITO group, the mean VAS scores never exceeded 1.9 and 3.5 at rest and during coughing/movement, respectively; and the maximal differences between the groups (TEA vs PVB+ITO) in the maximal VAS scores were only 1.2 (3.4 vs 4.6) at rest, and 1.3 (4.4 vs 5.7) during coughing/movement.
  
  
  CONCLUSIONS
  Although VAS scores were statistically lower in the TEA compared with the PVB+ITO group at some observation points, the differences were small and of questionable clinical relevance. Thus, combined PVB and ITO can be considered a satisfactory alternative to TEA for post-thoracotomy pain relief. ClinicalTrials.gov number. NCT00493909.
authors.affiliation: Department of Thoracic Surgery, University Medical Center, Hugstetter Strasse 55, D-79106 Freiburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dango
authors.forename: S
authors.initials: S
authors.lastname: Harris
authors.forename: K
authors.initials: K
authors.lastname: Offner
authors.forename: E
authors.initials: E
authors.lastname: Hennings
authors.forename: H-J
authors.initials: HJ
authors.lastname: Priebe
authors.forename: H
authors.initials: H
authors.lastname: Buerkle
authors.forename: B
authors.initials: B
authors.lastname: Passlick
authors.forename: T
authors.initials: T
authors.lastname: Loop
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use; D013904:Thoracic Vertebrae; D013908:Thoracotomy / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D009020:Morphine; D017409:Sufentanil