Patient-controlled paravertebral analgesia for video-assisted thoracoscopic surgery lobectomy

Abstract

BackgroundParavertebral block has been proven to be an efficient method to provide post-thoracotomy pain management. This study aimed to compare patient-controlled paravertebral analgesia (PCPA) and intravenous patient-controlled analgesia (IVPCA) in terms of analgesic efficiency, respiratory function, and adverse effects after video-assisted thoracoscopic surgery (VATS) lobectomy.Patients and methodsThe prospective randomized trial study was carried out on 60 patients who underwent VATS lobectomy (randomly allocated 30 patients in each group). In the PCPA group, an initial dose of 0.3 mL/kg of 0.125% bupivacaine with fentanyl 2 µg/mL was administered, followed by a 3 mL/h continuous infusion with patient-controlled analgesia (2 mL bolus, 10-minute lockout interval, 25 mL/4 h limit). In the IVPCA group with morphine 1 mg/mL solution, an infusion device was programmed to deliver a 1.0 mL demand bolus with no basal infusion rate, with a 10-minute lockout interval and a maximum of 20 mL/4 h period. Postoperative pain was assessed by visual analog scale at rest and on coughing. Arterial blood gas and spirometry were monitored and recorded for the first 3 postoperative days. Side effects to include were also recorded.ResultsThe PCPA group had statistically significant lower pain scores (P<0.0001) at rest at all times. Lower pain scores on coughing were statistically significant in PCPA group in the first 4 hours. Postoperative spirometry showed that both the groups had comparable recovery trajectories for their pulmonary function. Arterial blood gas analysis showed pH and PaCO2 were in a normal range in both the groups. The incidence of headache was higher in the IVPCA group (13.3% vs 0%; P=0.038).ConclusionPCPA effectively managed pain after VATS lobectomy, with lower pain scores, similar respiratory function, and fewer side effects than standard IVPCA treatment.

Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial

“…Our [29]. Pruritus (1.1%) or urinary retention (4.5%) was observed in a small proportion of the study population, which was relatively lower compared to other literatures using fentanyl [29], morphine [30] or hydromorphone [31]. No sedation or respiratory depression was observed in our trial, which was more common with morphine [32,33].…”

“…Our reported incidence of constipation (33.9%) and dizziness (22.9%) were similar to Lee et al’s study, in which constipation (28.9%) and dizziness (21.1%) were two most common side effects with opioid PCIA after thoracoscopic lobectomy [ 29 ]. Pruritus (1.1%) or urinary retention (4.5%) was observed in a small proportion of the study population, which was relatively lower compared to other literatures using fentanyl [ 29 ], morphine [ 30 ] or hydromorphone [ 31 ]. No sedation or respiratory depression was observed in our trial, which was more common with morphine [ 32 , 33 ].…”

PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

“…Giang et al. [ 26 ] compared this technique with i.v. morphine PCA and noted significantly lower pain scores only during the first 4 postoperative hours.…”

Paravertebral block with modified catheter under surgeon’s direct vision after video-assisted thoracoscopic lobectomy

“…Despite the methods of ultrasoundguide that can be applied, PVB using the classical landmark puncture technique is still considered not satisfactorily predictable (13)(14)(15). Recently, the method of catheter insertion into the paravertebral space which could be verified continuously by the surgeon using the camera is preferable in some centers (11,16). Furthermore, no gold standard for PVB device has been introduced for patients undergoing VATS so far, especially for the paravertebral catheter.…”