Ultrasound-Guided Paravertebral Catheter Versus Intercostal Blocks for Postoperative Pain Control in Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Trial.
OBJECTIVE
The use of continuous paravertebral (PV) catheters for management of acute postsurgical pain after video-assisted thoracoscopic surgery (VATS) has not been investigated previously as a randomized controlled trial. The purpose of this study was to compare the efficacy of an ultrasound-guided continuous PV catheter catheter infusion for postoperative pain control with single-shot intercostal blocks (ICB).


METHODS
A prospective, randomized, controlled trial.


METHODS
An academic university hospital.


METHODS
Patients (≥18 years of age) who underwent a VATS procedure.


METHODS
Patients were randomized into 2 groups. Group 1 received single-shot ICB. Group 2 received an ultrasound-guided PV catheter with a continuous infusion of 0.2% ropivacaine.


RESULTS
There were 25 patients in group 1 and 23 patients in group 2. The maximum pain score was significantly lower in the group that received the PV catheter compared with those who received ICB during 24 to 48 hours (3.65 v 6.44, p<0.001). Seventeen patients (74%) who received PV catheters reported satisfaction with a pain control regimen compared to the 11 (44%) who received ICB (p = 0.036). In addition, during 24 to 48 hours after surgery the mean opioid use decreased significantly in the PV catheter group (14.39 v 30.50 mg morphine equivalents, p = 0.046).


CONCLUSIONS
Ultrasound-guided continuous PV catheter infusions provided prolonged pain control and superior patient satisfaction compared with single-shot ICB after video-assisted thoracoscopic surgery.
Department of Anesthesiology, University of Minnesota, Minneapolis, MN. Electronic address: hutc0079@umn.edu.
Jacob
J
Hutchins
Department of Anesthesiology, University of Minnesota, Minneapolis, MN.
Jeremy
J
Sanchez
Department of Surgery, University of Minnesota, Minneapolis, MN.
Rafael
R
Andrade
Department of Surgery, University of Minnesota, Minneapolis, MN.
Eitan
E
Podgaetz
Biostatistics Design and Analysis Center, Minneapolis, MN.
Qi
Q
Wang
TRIA Orthopaedic Center, Bloomington, MN.
Robby
R
Sikka
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002404:Catheterization / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods* / Q000592:standards; D059408:Pain Management / Q000379:methods / Q000592:standards; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D010149:Postoperative Pain / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods* / Q000592:standards; D018084:Ultrasonography, Interventional / Q000379:methods* / Q000592:standards
D000779:Anesthetics, Local
acute pain; intercostal blocks; nerve block; paravertebral blocks; postoperative pain