Persistent Postsurgical Pain Following Thoracotomy: A Comparison of Thoracic Epidural and Paravertebral Blockade as Preventive Analgesia

• Published in: Pain medicine (Malden, Mass.) Vol. 20; no. 9; pp. 1796 - 1802
• Main Authors: Wong, Jonathon, Cooper, Jackie, Thomas, Rik, Langford, Richard, Anwar, Sibtain
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.09.2019
• Subjects: Analgesia; Bupivacaine; Chronic pain; Comparative analysis; Neuralgia; Ostomy; Pain; Pain perception; Public-private sector cooperation; Quality of life; Thorax; United Kingdom; Paravertebral Block; Persistent Postsurgical Pain; Thoracic Epidural; Thoracotomy; Chronic Pain
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pny293

Persistent postsurgical pain (PPP) is common following thoracotomy. Thoracic epidural (TEB) and paravertebral blockade (PVB) are both established forms of perioperative analgesia for thoracotomy. There is currently a lack of data on their influence on PPP; this study aims to evaluate both techniques on PPP. Observational study, prospectively collected data. Adults who underwent thoracotomy had either TEB or PVB for analgesia and were prospectively interviewed at six months. A numerical rating scale, the short form of the Leeds Assessment of Neuropathic Symptoms and Signs, and the EuroQol-5 dimension (EQ-5D) index were used to assess pain, neuropathic pain, and quality of life. Eighty-two patients who underwent a thoracotomy were recruited (TEB N = 36, PVB N = 46). Pain scores had a median (interquartile range [IQR]) of 1 (0 to 4.5) and 1.5 (0 to 4, P = 0.89), presence of PPP was 58.3% (95% confidence interval [CI] = 40.0-74.5%) and 60.9% (95% CI = 45.4-74.9%, P = 0.81), and presence of neuropathic pain was 30.6% (95% CI = 16.3-48.1%) and 28.2% (95% CI = 16.0-43.5%, P = 0.85). Reported quality of life was 0.71 (0.14-0.85) and 0.80 (0.19-0.91, P = 0.21). Patients who had PPP reported worse quality of life measures compared with those who were pain free, with a median (IQR) EQ-5D index of 0.69 (-0.15 to 0.85) and 0.85 (0.72 to 1, P = 0.0007); quality of life was worst when there was a neuropathic component (median = 0.39, IQR = -0.24 to 0.75). There was no statistical difference in the development of persistent postsurgical pain between patients who received a TEB or a PVB; however, patients who developed PPP had a significantly lower quality of life, which was worse with a neuropathic component.