Continuous paravertebral extrapleural infusion for post-thoracotomy pain management

• Published in: Surgery Vol. 126; no. 4; pp. 650 - 657
• Main Authors: Bimston, David N., McGee, John Paul, Liptay, Michael J., Fry, Willard A.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.10.1999
• Subjects: Anesthesia, Epidural - adverse effects; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Anesthetics, Local - blood; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Bupivacaine - blood; Catheterization - methods; Fentanyl - administration & dosage; Fentanyl - adverse effects; Forced Expiratory Volume; Humans; Lung Diseases - surgery; Narcotics - administration & dosage; Narcotics - adverse effects; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pleura; Pneumonectomy; Prospective Studies; Pruritus - chemically induced; Thoracotomy; Urinary Retention - chemically induced; Vital Capacity
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(99)70118-2

Background: Continuous thoracic epidural analgesia is considered by many the gold standard for post-thoracotomy pain control but is associated with its own complications. In this study we compare continuous paravertebral extrapleural to epidural infusion for post-thoracotomy pain control. Methods: In a prospective fashion, 50 patients were randomized to receive either paravertebral or epidural infusion for post-thoracotomy pain control. The anesthesia department placed epidurals, and the operative surgeon placed unilateral paravertebral catheters. Patients were evaluated for analgesic efficacy and postoperative complications. Results: We found that both methods of analgesia provide adequate postoperative pain control. Epidural infusion demonstrated an improved efficacy early in the postoperative course but provided statistically similar analgesia to paravertebral by postoperative day 2. Neither group demonstrated a greater number of pain-related complications. Narcotic-induced complications such as pruritus, nausea/vomiting, and postural hypotension/mental status changes/respiratory depression were seen with statistically similar frequency in both epidural and paravertebral arms. Urinary retention, however, was noted to be significantly more frequent in patients with epidural catheters. Drug toxicity was not observed with either epidural or paravertebral infusion. Conclusions: We recommend continuous paravertebral infusion as an improved method of post-thoracotomy analgesia that can be placed and managed by the surgeon. (Surgery 1999;126:650-7.)