A prospective, randomised comparison of continuous paravertebral block and continuous intercostal nerve block for post-thoracotomy pain

Abstract

Background: This study aimed to compare paravertebral block and continuous intercostal nerve block after thoracotomy. Methods: Forty-six adult patients undergoing elective posterolateral thoracotomy were randomised to receive either a continuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessed for 48 hours .Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals. Results: With respect to the objective visual assessment (VAS), both techniques were effective for post thoracotomy pain. The average VAS score at rest was 29±10mm for paravertebral block and 31.5±11mm for continuous intercostal nerve block. The average VAS score on coughing was 36±14mm for the first one and 4 ±14mm for the second group. Pain at rest was similar in both groups. Pain scores on coughing were lower in paravertebral block group at 42 and 48 hours. Post-thoracotomy function was better preserved with paravertebral block. No difference was found among the two groups for side effects related to technique, major morbidity or duration of hospitalisation. Conclusion: We found that continuous intercostal nerve block and paravertebral block were effective and safe methods for post-thoracotomy pain.

Efficacy and safety of paravertebral block versus intercostal nerve block in thoracic surgery and breast surgery: A systematic review and meta-analysis

“…The VAS on coughing at 8 hours after surgery between PVB and INB reported in Chen et.al [ 14 ] had significant difference. There was also a significant difference in the VAS on coughing at 24hours and 48 hours after operation reported by Ouerghi et.al [ 20 ] and the VAS on coughing at 1hour and 2 hour after operation reported by Chen et.al [ 19 ], and the other studies included did not find any differences in the VAS on coughing in each period of time.…”

“…We used the random-effect model to analysis the outcome of postoperative use of morphine in three trials Hutchins (2017), Perttunen (1995) and Ouerghi (2008) [ 18 , 20 , 21 ]. The results showed that compared to INB, PVB can result in a significantly decrease in postoperative morphine (Std.…”

Efficacy of paravertebral block techniques in thoracic surgery

“…Para la técnica de BPV-AS (n = 393), la media de dolor en EVA fue menor o igual a 4 en el POP inmediato en los estudios que lo reportaron, al igual que en las 6, 12, 24 y 48 horas posoperatorias en casi todos los estudios, excepto en el de Ouerghi et al 21 y Kosisnski et al, 26 en los cuales el dolor POP tuvo alta variabilidad. Ambos estudios compararon el bloqueo epidural frente al BPV-AS, encontrando diferencia a favor del epidural.…”

“…En la Figura 4 se muestra el resumen de consumo de morfina para las técnicas en el POP, y en el Anexo 5 (CDC) el reporte de consumo de morfina para cada estudio. Solo en 8 de los estudios donde se realiz o el BVP-AS fue posible determinar el consumo de opioides en equivalentes de morfina, 18,[21][22][23]26,27,30,31 en los cuales se emple o catéter paravertebral como técnica analgésica POP.…”

“…La técnica de colocaci on del BPV empleada en los diferentes estudios fue el BPV-AS en 13 de ellos. 18,[20][21][22][23][24][25][26][27][28][29][30][31] La principal técnica utilizada por los investigadores en estos estudios fue la guía mediante referencias anat omicas tomadas previamente por anatomía de superficie, y en pocos casos, marcaci on ecográfica previa del sitio de punci on. Se realiz o pérdida de resistencia tanto con aire como con soluci on salina, de acuerdo con la directriz institucional o lo establecido en el protocolo del estudio.…”