Comparison of Continuous Paravertebral and Extradural Infusions of Bupivacaine for Pain Relief After Thoracotomy

Abstract

Pain was controlled in 20 post-thoracotomy patients using a continuous infusion of 0.25% bupivacaine through an extradural or para-vertebral catheter. Both techniques provided good analgesia. Hypotension and urine retention occurred significantly less frequently in the paravertebral than in the extradural group.

Placement of coiled catheters into the paravertebral space*

“…The intercostal nerves were reached in all cases by the contrast. The median IQR [range] cranio-caudal spread of dye was 4 (4-5 [3][4][5][6][7][8]) thoracic segments; in one case, a significant portion reached the pre-vertebral space. In 11 ⁄ 20 (55%) cases, a small amount of contrast dye (approximately 1 ml) could be detected in the epidural space with a median IQR [range] cranio-caudal spread of 4 (2-7 [1-15])thoracic segments.…”

“…Paravertebral blockade is a regional anaesthetic technique that can be used for analgesia after thoracic surgery [1][2][3][4], cardiac surgery [5], breast surgery [6][7][8] or upper abdominal surgery [9], or for chronic pain therapy [10]. A thoracic paravertebral block is performed by injecting local anaesthetic solution into the paravertebral space, which contains the thoracic nerves, their branches and the sympathetic trunk.…”

Paravertebral blockade

“…He also demonstrated the benefit of paravertebral blockade after thoracotomy [3]. Paravertebra1 block reduces the stress response to cholecystectomy [4], provides equally effective post-thoracotomy pain relief with fewer complications than thoracic epidural analgesia [5] and has been used successfully in the care of patients in chronic pain [6]. The method has recently been modified for children with promising results [7,8].…”

Thoracic Paravertebral Block, a Suitable and Safe Adjunct for General Anaesthesia, for Post-Operative Pain Relief in Modified Radical Mastectomies

“…PVB offers an added benefit of reducing the incidence of PONV. 3,9,10,11 . the incidence of nausea and vomiting after breast cancer surgery with general anaesthesia in the first 24 hrs `is59%.…”