Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery.
OBJECTIVE
Both paravertebral block (PVB) and thoracic epidural block (TEB) are recommended for postoperative pain relief after lung surgery. The addition of fentanyl to the anesthetic solution became popular for TEB because of the stronger effects; however, there have been few comparable trials about the addition of fentanyl to PVB. The purpose of this study was thus to compare postoperative analgesia, side effects, and complications between ultrasound-guided PVB (USG-PVB) and TEB with the addition of fentanyl to ropivacaine after lung surgery.


METHODS
We examined 90 consecutive patients (age 18-75 years) scheduled for video-assisted thoracic surgery (VATS). In both groups, all blocks (four blocks in USG-PVB and one block in TEB) and one catheter insertion were performed preoperatively. Continuous postoperative infusion (0.1% ropivacaine plus fentanyl at 0.4 mg/day) was undertaken for 36 h in both groups. The recorded data included the verbal rating scale (VRS) for pain, blood pressure, side effects, complications for 2 days, and overall satisfaction score.


RESULTS
There was no difference in the frequency of taking supplemental analgesics (twice or more frequently), or in VRS. Hypotension occurred significantly more frequently in TEB (n = 7/33) than in PVB (n = 1/36) (P = 0.02); on the other hand, the incidences of PONV and pruritus, as well as overall satisfaction score, were similar. There were no complications in both groups; however, the catheters migrated intrathoracically in four patients in PVB.


CONCLUSIONS
USG-PVB achieved similar pain relief and lowered the incidence of hypotension compared with TEB. We conclude that both blocks with the same concentration of ropivacaine and fentanyl can provide adequate postoperative analgesia for VATS.
Department of Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe, Hyogo, 651-2273, Japan. hanae1123catseeye@hotmail.com.
Hanae
H
Okajima
Department of Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe, Hyogo, 651-2273, Japan.
Osamu
O
Tanaka
Department of Anesthesiology, Kakogawa West City Hospital, 384-1 Yonedachohiratsu, Kakogawa, Hyogo, 675-8611, Japan.
Masahiro
M
Ushio
Department of Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe, Hyogo, 651-2273, Japan.
Yasuko
Y
Higuchi
Department of Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe, Hyogo, 651-2273, Japan.
Yukiko
Y
Nagai
Department of Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe, Hyogo, 651-2273, Japan.
Katsuhiro
K
Iijima
Department of Anesthesiology, Hyogo Brain and Heart Center At Himeji, 520 Saisyo-ko, Himeji-city, Hyogo, 670-0981, Japan.
Yoshio
Y
Horikawa
Department of Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe, Hyogo, 651-2273, Japan.
Kazuko
K
Ijichi
D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000700:Analgesics / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D013510:Pulmonary Surgical Procedures / Q000379:methods; D000077212:Ropivacaine; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*
D000577:Amides; D000700:Analgesics; D000077212:Ropivacaine; D005283:Fentanyl