Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Abstract

Aim: Thoracotomy is among the most painful surgical incisions and causes severe acute pain in the postoperative period. Many analgesic methods have been suggested for thoracotomy pain treatment. Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are common regional methods for post-thoracotomy pain. In this study, we aimed to compare the efficacy and the side effects of TEA and TPVB methods applied for post-thoracotomy analgesia. Material and Method: After ethical committee approval, we retrospectively analyzed postoperative analgesia records of patients, who underwent thoracotomy, received TEA or TPVB for postoperative analgesia between 01.01.2019 and 01.01.2021. Visual analog scale (VAS) scores of the patients who received analgesic treatment for 24 hours postoperatively after TEA or TPVB application were evaluated. Results: Data of 474 patients were found eligible for analysis. Demographic data of patients, VAS scores, patient satisfaction, and additional analgesic requirements were not statistically significant between the groups (p>0.05). Nausea-vomiting, hypotension, headache, itching, and sweating was statistically significantly higher in the TEA group when compared to patients who underwent TPVB (p<0.05). Conclusion: In the present study, in the early postoperative pain management after thoracotomy; it was observed that preemptive TPVB and postoperative IV patient-controlled analgesia (PCA) and TEA provided similar VAS scores and additional analgesic requirements. On the other hand, postoperative complications were observed less frequently in patients who underwent TPVB with postoperative IV PCA compared to TEA. Therefore, TPVB may be a good alternative to prevent acute pain after thoracotomy.

Keywords

• Postoperative acute pain
• thoracic epidural analgesia
• thoracic paravertebral block
• thoracotomy

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