Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Abstract

Background: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. Methods: Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. Results: Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). Conclusions: Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.

Continuous surgical multi-level extrapleural block for video-assisted thoracoscopic surgery: a retrospective study assessing its efficacy as pain relief following lobectomy and wedge resection

“…Addition of adrenaline might allow for more local anaesthetics to be infused. Kosiński et al 11 observed that better analgesia was achieved using a mixture of bupivacaine and adrenaline when infused through a continuous paravertebral block rather than continuous epidural, even implying an additive effect of adrenaline itself. Future trials should address systemic absorption and toxicity for continuous blocks, measuring plasma concentrations of the local anaesthetic used.…”

“…No firm conclusion could be drawn assessing available evidence around thoracic epidural, multilevel and single paravertebral, paravertebral catheter, intercostal catheter, interpleural infusion and long thoracic nerve block. The most recent study comparing epidural and percutaneous paravertebral block by Kosiński et al 11 showed that the paravertebral continuous block technique was a feasible and safe alternative to epidural analgesia. Hutchins et al 12 found ultrasound-guided continuous paravertebral catheter to provide prolonged pain control and superior patient satisfaction compared with single-shot intercostal block after VATS.…”

The role of regional analgesia in personalized postoperative pain management

“…Targeted regional analgesia can also reduce unwanted adverse effects after some surgeries. A paravertebral block may offer equivalent analgesic benefit to a thoracic epidural, with lower rates of urinary retention and hypotension in those undergoing thoracic surgery [40][41][42]. Fascial plane blocks, such as TAP, rectus sheath, or ESP blocks, can provide analgesia for abdominal procedures while avoiding sympathetic block and hypotension encountered with a thoracic epidural and the risk of epidural hematoma in patients with coagulopathy [20].…”

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

“…PVB and INB have been popular methods of postoperative analgesia in the recent years because of the popular use of ultrasound [4]. Compared with the traditional standard of epidural analgesia, it has the advantages of less effect on respiratory or circulation system and less postoperative complications such as epidural hematomas and irreversible neurological disorder [5][6], which can also be applied to patients with coagulation dysfunction.…”