title: Paravertebral Catheter Use for Postoperative Pain Control in Patients After Lung Transplant Surgery: A Prospective Observational Study.
abstract: OBJECTIVE
  Effective postoperative pain management has been shown to be a positive predictive factor for postoperative recovery following a thoracotomy. The primary objective of this study was to examine the efficacy and safety of continuous paravertebral blockade in managing acute postsurgical pain following unilateral and bilateral single-lung transplantation.
  
  
  METHODS
  The authors conducted a prospective observational trial of patients.
  
  
  METHODS
  The study was conducted in an academic university hospital.
  
  
  METHODS
  Patients (≥18 years of age) who underwent either unilateral or bilateral single-lung transplantation and received a postoperative paravertebral catheter.
  
  
  METHODS
  Paravertebral catheters were placed via an ultrasound-guided technique on either postoperative day 1 or 2. After placement, a continuous infusion of 0.2% ropivacaine was run at 0.2 to 0.25 mL/kg/h with maximum dose of 7 mL/h per side in bilateral lung transplant patients, and 14 mL/h in unilateral lung transplant patients.
  
  
  RESULTS
  Patients were followed up to 120 hours after placement of catheters, and pain scores, opioid use, and adverse events were recorded. There were 35 patients who completed the study from October 2013 to December 2014 (21 bilateral transplants and 14 unilateral transplants). The mean time to paravertebral catheter placement was 1.14 days in the overall group, with median time to extubation occurring 543 minutes after placement (range, 23-2,985 minutes). Catheters remained in place for a mean of 7.18 days. The mean maximal pain scores for both groups was 5.94 (day 1), 6.26 (day 2), 6.20 (day 3), 5.12 (day 4), and 5.60 (day 5). There were no adverse events related to the paravertebral catheters in either group.
  
  
  CONCLUSIONS
  Paravertebral catheters provide a feasible option for postoperative pain control following unilateral or bilateral single-lung transplant in adult patients. Future research should focus on randomized trials of thoracic epidurals compared to paravertebral catheters.
authors.affiliation: Department of Anesthesiologyy, University of Minnesota, Minneapolis, MN. Electronic address: hutc0079@umn.edu.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hutchins
authors.affiliation: Department of Anesthesiologyy, University of Minnesota, Minneapolis, MN.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Apostolidou
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Sara
authors.initials: S
authors.lastname: Shumway
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Kelly
authors.affiliation: Biostatistics Design and Analysis Center, University of Minnesota, Minneapolis, MN.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Anesthesiologyy, University of Minnesota, Minneapolis, MN.
authors.forename: Cody
authors.initials: C
authors.lastname: Foster
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Loor
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D000077212:Ropivacaine; D013904:Thoracic Vertebrae; D013908:Thoracotomy / Q000009:adverse effects; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: acute pain; lung transplantation; nerve block; pain; paravertebral block; postoperative