[Continuous epidural anaesthesia vs paravertebral block for lung surgery--a comparative study].

BACKGROUND

This prospective randomized study compared the effects of two techniques--thoracic epidural analgesia (TEA), and thoracic paravertebral analgesia (TPVA), on pain control and haemodynamics after thoracotomy.

METHODS

Sixty adult ASA 1 and 2 patients were randomly assigned to two equal groups to receive either: (I) 10 mL of 0.5% bupivacaine before and at the end of surgery via a thoracic epidural catheter; or (II) 30 mL of 0.5% bupivacaine before, and 15 mL at the end of surgery, via a thoracic paravertebral catheter. During the postoperative period, patients of both groups received continuous infusion of 0.1 mL kg(-1) h(-1) into the respective spaces. This technique was supplemented by patient-controlled intravenous infusion of fentanyl (bolus 0.02 mg; lock-out time 12 min).

RESULTS

The average dose of fentanyl administered intraoperatively in both groups was similar. Blood pressure and heart rate were significantly lower in the TEA group. Pain intensity, assessed using the NRS and PHHPS scales, was similar in both groups. PCA fentanyl consumption was higher in theTPVA group.

CONCLUSIONS

(1) Thoracic paravertebral anaesthesia can be regarded as a satisfactory alternative to epidural anaesthesia for control of post-thoracotomy pain. (2) The effect of paravertebral anaesthesia on blood pressure and heart rate is minimal, therefore this technique may be recommended for patients with coexisting circulatory disease. (3) The frequency of use of the PCA system cannot be regarded as an objective method of pain assessment.