Thoracic paravertebral block after thoracotomy: comparison of three different approaches

Background: Thoracic paravertebral block (TPVB) is a regional block technique increasingly used for the early management of post-thoracotomy pain. We compare three different postoperative analgesic approaches based on TPVB: anesthetist, anesthetist plus surgeon, and surgeon. Materials and methods: We randomized 54 patients undergoing elective thoracotomy to three different postoperative analgesia groups: paravertebral percutaneous catheter (PVA group), paravertebral percutaneous catheter plus incisional (subcutaneous) catheter (PVA + Inc), and paravertebral. catheter under direct vision (PVS group). During early postoperative 48 h, we measured pain intensity, intravenous morphine afforded by the patient-control led analgesia pump, and the spirometric test. Results: There were no statistically significant differences among the collected preoperative data. No significant differences were observed on postoperative spirometric values. Analgesic quality was better in PVA + Inc group at 12 and 24 postoperative hours. In this group, intravenous morphine use to improve analgesia was significantly tower from 8 h until 48 h postoperative. Conclusions: Association of thoracic paravertebral block to continuous infusion of a local anesthetic in the surgical incision area affords a better pain relief than paravertebral Mock alone (introduced by the surgeon or the anesthetist). (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.