Comparative evaluation of continuous thoracic paravertebral block and thoracic epidural analgesia techniques for post-operative pain relief in patients undergoing open nephrectomy: A prospective, randomized, single-blind study

Abstract Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

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Are paravertebral block and thoracic epidural analgesia comparable for post-thoracotomy pain relief? A systematic review

European Journal of Anaesthesiology ◽

10.1097/00003643-200606001-00418 ◽

2006 ◽

Vol 23 (Supplement 37) ◽

pp. 117

Author(s):

F. Bonnet ◽

G. Joshi ◽

R. Shah

Keyword(s):

Systematic Review ◽

Pain Relief ◽

Epidural Analgesia ◽

Thoracic Epidural Analgesia ◽

Paravertebral Block ◽

Thoracic Epidural

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Superior postoperative pain relief with thoracic epidural analgesia versus intravenous patient-controlled analgesia after minimally invasive pectus excavatum repair

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.05.050 ◽

2007 ◽

Vol 134 (4) ◽

pp. 865-870 ◽

Cited By ~ 62

Author(s):

Thomas Weber ◽

Johanna Mätzl ◽

Alexander Rokitansky ◽

Walter Klimscha ◽

Konrad Neumann ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Minimally Invasive ◽

Epidural Analgesia ◽

Pectus Excavatum ◽

Thoracic Epidural Analgesia ◽

Postoperative Pain Relief ◽

Patient Controlled Analgesia ◽

Thoracic Epidural

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Postoperative Analgesia after Radical Retropubic Prostatectomy

Anesthesiology ◽

10.1097/00000542-200610000-00025 ◽

2006 ◽

Vol 105 (4) ◽

pp. 784-793 ◽

Cited By ~ 35

Author(s):

Anil Gupta ◽

Federica Fant ◽

Kjell Axelsson ◽

Dag Sandblom ◽

Jan Rykowski ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Epidural Analgesia ◽

Short Form ◽

Radical Retropubic Prostatectomy ◽

Thoracic Epidural Analgesia ◽

Short Form 36 ◽

Thoracic Epidural ◽

Retropubic Prostatectomy ◽

Intravenous Analgesia

Background Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated. Low thoracic epidural analgesia and patient-controlled intravenous analgesia were compared in this double-blind, randomized study. Methods Sixty patients were randomly assigned to receive either low thoracic epidural analgesia (group E) or patient-controlled intravenous analgesia (group P) for postoperative pain relief. All patients had general anesthesia combined with thoracic epidural analgesia during the operation. Postoperatively, patients in group E received an infusion of 1 mg/ml ropivacaine, 2 microg/ml fentanyl, and 2 microg/ml adrenaline, 10 ml/h during 48 h epidurally, and a placebo patient-controlled intravenous analgesia pump intravenously. Patients in group P received a patient-controlled intravenous analgesia pump with morphine intravenously and 10 ml/h placebo epidurally. Pain, the primary outcome variable, was measured using the numeric rating scale at rest (incision pain and "deep" visceral pain) and on coughing. Secondary outcome variables included gastrointestinal function, respiratory function, mobilization, and full recovery. Health-related quality of life was measured using the Short Form-36 questionnaire, and plasma concentration of fentanyl was measured in five patients to exclude a systemic effect of fentanyl. Results Incisional pain and pain on coughing were lower in group E compared with group P at 2-24 h, as was deep pain between 3 and 24 h postoperatively (P < 0.05). Maximum expiratory pressure was greater in group E at 4 and 24 h (P < 0.05) compared with group P. No difference in time to home discharge was found between the groups. The mean plasma fentanyl concentration varied from 0.2 to 0.3 ng/ml during 0-48 h postoperatively. At 1 month, the scores on emotional role, physical functioning, and general health of the Short Form-36 were higher in group E compared with group P. However, no group x time interaction was found in the Short Form-36. Conclusions The authors found evidence for better pain relief and improved expiratory muscle function in patients receiving low thoracic epidural analgesia compared with patient-controlled analgesia for radical retropubic prostatectomy. Low thoracic epidural analgesia can be recommended as a good method for postoperative analgesia after abdominal surgery.

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