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A Comparison of Analgesia After a Thoracoscopic Lung Cancer Operation with a Sustained Epidural Block and a Sustained Paravertebral Block: A Randomized Controlled Study

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Abstract

Introduction

This study aimed to compare the challenge of puncture and catheterization and the effect of postoperative analgesia of ultrasound-guided continuous thoracic paravertebral block and the continuous epidural analgesia in patients receiving thoracoscopic surgery for lung cancer.

Methods

One-hundred and fifty patients received elective unilateral thoracoscopic surgery for lung cancer and were randomized into three groups; test group 1 (T group), test group 2 (P group), and the control group (E group). Both of the test groups received ultrasound-guided continuous thoracic paravertebral block (TPVB) while the control group received continuous epidural analgesia. After the operation, all the patients in the test groups received the same postoperative analgesia; loading dose 0.5 mg kg−1, background dose 0.25 mg kg−1 h−1, patient controlled analgesia (PCA) 0.25 mg kg−1, and a locking time of 60 min, while the patients in the control group received a loading dose of 5 ml, a background dose of 5 ml h−1, and a locking time of 20 min. The outcomes of this study were the success rate of the puncture and catheter placement, the blocked segments, numerical rating scale (NRS) scores at rest and during coughing, and the segments with reduced or lost cold and pinpricking sensation.

Results

The success rates of the puncture and catheterization in group T were the highest. Compared with group P, the failure rate of the puncture in group E was lower (p < 0.05), but the success rate of catheterization was higher (p < 0.05). The puncture time in group T was the shortest; there was no difference between group E and group T. The time of catheterization in group P was the longest, this was followed by group T, and was the fastest in group E. The stable time of the block level in group E was shorter than that in groups P and T, but was similar between groups P and T. The block level of all three groups in the 4 h postoperative period was similar (p > 0.05), while the 4 h postoperative levels of groups P and T were reduced significantly (p < 0.05).

Conclusion

The continuous analgesia technique of paravertebral space catheterization cannot replace the continuous epidural analgesia in thoracoscopic lung cancer surgery as the latter technique is still considered to be the gold standard.

Trial Registration

China Clinical Trial Registration Center identifier ChiCTR1900020973.

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Acknowledgements

Funding

This research was supported by Fujian Natural Science Foundation, China (No. 2018J01206). The journal’s Rapid Service Fee was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Qiao-Wen Huang, Jia-Bin Li, Ye Huang, Wen-Qing Zhang and Zhi-Wei Lu have nothing to disclose.

Compliance with Ethics Guidelines

This study was approved by the Ethics Committee of the Zhangzhou Municipal Hospital of Fujian Province (2018-lx-002) and was registered in the China Clinical Trial Registration Center (ChiCTR1900020973, https://www.chictr.org.cn). We also received written informed consent from the patients and/or their families. The study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.

Data Availability

All data generated or analyzed during this study are included in this published article/as supplementary information files.

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Authors and Affiliations

  1. Department of Anesthesiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China

    Qiao-Wen Huang, Jia-Bin Li, Ye Huang, Wen-Qing Zhang & Zhi-Wei Lu

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  1. Qiao-Wen Huang
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Correspondence to Zhi-Wei Lu.

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Huang, QW., Li, JB., Huang, Y. et al. A Comparison of Analgesia After a Thoracoscopic Lung Cancer Operation with a Sustained Epidural Block and a Sustained Paravertebral Block: A Randomized Controlled Study. Adv Ther 37, 4000–4014 (2020). https://doi.org/10.1007/s12325-020-01446-3

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