A Prospective, Randomized, Blinded Comparison Between Continuous Thoracic Paravertebral and Epidural Infusion of 0.2% Ropivacaine After Lung Resection Surgery.
From: University of Parma, Department of Anaesthesiology and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy. acasati@ao.pr.it
European journal of anaesthesiology
- Publish Date: Dec 2006
- ISSN: 0265-0215
- Volume: 23
- Issue: 12
- Pages: 999-1004
- Medium: Print
- Language: English
- Citation (JAMA): Casati A, Alessandrini P, Nuzzi M, et al. A Prospective, Randomized, Blinded Comparison Between Continuous Thoracic Paravertebral and Epidural Infusion of 0.2% Ropivacaine After Lung Resection Surgery.. Dec 2006;23:999-1004
Abstract
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.
Mesh Headings (Keywords): Adult, Aged, Amides, Analgesia, Epidural, Anesthetics, Local, Blood Pressure, Double-Blind Method, Drug Administration Routes, Female, Humans, Injections, Spinal, Lung, Male, Middle Aged, Pain, Postoperative, Prospective Studies, Thoracotomy, Time Factors
Check for Full Text / PubMed Unique Identifier (PMID): 16824243
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