COMPARISON BETWEEN THORACIC EPIDURAL AND PARAVERTEBRAL BLOCK TECHNIQUE FOR POSTOPERATIVE ANALGESIA IN THORACOTOMY
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i5.47085Keywords:
Thoracotomy, Epidural block, Paravertebral block, AnesthesiaAbstract
Objectives: The present study was planned to compare paravertebral block with conventional thoracic epidural technique in terms of efficacy, duration of analgesia, and complications in patients undergoing thoracotomy.
Methods: A prospective randomized, double-blinded control study was conducted at King George Hospital adults undergoing thoracotomy between January 2020 and June 2021 after getting permission from the institutional ethical committee and getting consent from the patient. Patients were allocated into two groups by simple random sampling: Group A – patients receiving thoracic epidural anesthesia and Group B – patients receiving paravertebral blocks. The total sample size of the study was 32. Under strictly controlled aseptic conditions, a Tuohy needle was inserted in the midline of the thorax, and the epidural space was verified using the loss of resistance technique. The catheter was secured after being inserted via the needle. The surgeon in Group B inserted a Tuohy needle into the paravertebral space under direct view after the procedure.
Results: The age distribution of study subjects in both the groups was similar, and only a minor difference was observed. The difference in mean age between the two groups was not statistically significant (p>0.05); hence, both the groups were comparable. There was a statistically significant difference between the mean MAP between the two groups throughout the postoperative period. There was a statistically significant variation in mean value of in the mean arterial pressure over time as p<0.05. However, this variation in MAP was minimal in subjects who received paravertebral block compared to a statistically significant drop in MAP among subjects who received epidural block. This difference in MAP variation between the two groups was statistically significant. The minor difference in mean PEFR between the two groups was not statistically significant (p>0.05); hence, both the groups were comparable regarding PEFR.
Conclusion: From the present study, TPVA and TEA are helpful for pain relief, and the technique selection should depend on the patient profile, clinical scenario, and expertise of the anesthesiologist in the regional approach available.
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References
Chu L, Zhang X, Lu Y, Xie G, Song S, Fang X, et al. Improved analgesic effect of paravertebral blocks before and after video-assisted thoracic surgery: A prospective, double-blinded, randomized controlled trial. Pain Res Manag 2019;2019:9158653. doi: 10.1155/2019/9158653, PMID 31827657
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy-a systematic review and meta-analysis of randomized trials. Br J Anaesth 2006;96:418-26. doi: 10.1093/bja/ael020, PMID 16476698
Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 1999;83:387-92. doi: 10.1093/bja/83.3.387, PMID 10655907
Sabanathan S, Richardson J, Mearns AJ. Management of pain in thoracic surgery. Br J Hosp Med 2003;50:114-20. PMID 8353663
Norum HM, Breivik H. A systematic review of comparative studies indicates that paravertebral block is neither superior nor safer than epidural analgesia for pain after thoracotomy. Scand J Pain 2010;1:12- 23. doi: 10.1016/j.sjpain.2009.10.003, PMID 29913936
Richardson J, Sabanathan S, Shah R. Post-thoracotomy spirometric lung function: The effect of analgesia. A review. J Cardiovasc Surg (Torino) 1999;40:445-56. PMID 10412938
Kim SH, Song GS, Son DW, Lee SW. Neurologic complication following spinal epidural anesthesia in a patient with spinal intradural extramedullary tumor. J Korean Neurosurg Soc 2010;48:544-6. doi: 10.3340/jkns.2010.48.6.544. PMID 21430985, PMCID PMC3053553
Batra RK, Krishnan K, Agarwal A. Paravertebral block. J Anaesthesiol Clin Pharmacol 2011;27:5-11. doi: 10.4103/0970-9185.76608, PMID 21804697, PMCID PMC3146159
Edgecombe L, Sigmon DF, Galuska MA, Angus LD. Thoracic trauma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
Doroshenko M, Turkot O, Horn DB. Sympathetic nerve block. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
Kommuru H, Jothi S, Bapuji P, Sree DL, Antony J. Thoracic part of sympathetic chain and its branching pattern variations in south Indian cadavers. J Clin Diagn Res 2014;8:AC09-12. doi: 10.7860/JCDR/2014/9274.5246. PMID 25653929, PMCID PMC4316235
Kelsheimer B, Williams C, Kelsheimer C. New emerging modalities to treat post-thoracotomy pain syndrome: A review. Mo Med 2019;116:41- 4. PMID 30862984, PMCID PMC6390789
Piraccini E, Pretto EA Jr., Corso RM, Gambale G. Analgesia for thoracic surgery: The role of paravertebral block. HSR Proc Intensive Care Cardiovasc Anesth 2011;3:157-60. PMID 23439717, PMCID PMC3484628
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