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A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery

Published online by Cambridge University Press:  07 July 2006

A. Casati ,
P. Alessandrini ,
M. Nuzzi ,
M. Tosi ,
E. Iotti ,
L. Ampollini ,
A. Bobbio ,
E. Rossini  and
G. Fanelli
A. Casati
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
P. Alessandrini
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
M. Nuzzi
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
M. Tosi
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
E. Iotti
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
L. Ampollini
Affiliation:
University of Parma, Department of Thoracic Surgery, Ospedale Maggiore di Parma, Parma, Italy
A. Bobbio
Affiliation:
University of Parma, Department of Thoracic Surgery, Ospedale Maggiore di Parma, Parma, Italy
E. Rossini
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
G. Fanelli
Affiliation:
University of Parma, Department of Anaesthesiology and Pain Therapy, Parma, Italy
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Abstract

Summary

Background: The aim of this prospective, randomized, blinded study was to compare analgesic efficacy of continuous paravertebral and epidural analgesia for post-thoracotomy pain. Methods: Forty-two ASA physical status II–III patients undergoing lung resection surgery were randomly allocated to receive post-thoracotomy analgesia with either a thoracic epidural (group EPI, n = 21) or paravertebral (group PVB, n = 21) infusion of 0.2% ropivacaine (infusion rate: 5–10 mL h−1). The degree of pain at rest and during coughing, haemodynamic variables and blood gas analysis were recorded every 12 h for the first 48 h. Results: The area under the curve of the visual analogue pain score during coughing over time was 192 (60–444) cm h−1 in group EPI and 228 (72–456) cm h−1 in group PVB (P = 0.29). Rescue morphine analgesia was required in four patients of group EPI (19%) and five patients of group PVB (23%) (P = 0.99). The PaO2/FiO2 ratio reduced significantly from baseline values in both groups without between-group differences. The median (range) percentage reduction of systolic arterial pressure from baseline was −9 (0 to −9)% in group PVB and −17 (0 to −38)% in group EPI (P = 0.02); while clinically relevant hypotension (systolic arterial pressure decrease >30% of baseline) was observed in four patients of group EPI only (19%) (P = 0.04). Patient satisfaction with the analgesia technique was 8.5 (8–9.8) cm in group EPI and 9 (7.5–10) cm in group PVB (P = 0.65). Conclusions: Continuous thoracic paravertebral analgesia is as effective as epidural blockade in controlling post-thoracotomy pain, but is associated with less haemodynamic effects.

Keywords

POSTOPERATIVE PERIOD, analgesiaTHORACIC SURGERY, postoperative complicationsANAESTHESIA, EPIDURALANAESTHESIA CONDUCTION, paravertebral blockLOCAL ANAESTHETIC AGENTS, ropivacaine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 999 - 1004
Copyright
2006 European Society of Anaesthesiology

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