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A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief

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Abstract

Purpose

We conducted a comparative study to evaluate analgesic efficacy between paravertebral block via the surgical field (PVB-sf), in which the catheter was inserted into the ventral side of the sympathetic trunk in the paravertebral space by a thoracic surgeon under thoracoscopic visualization, and epidural block (Epi) using ropivacaine for post-thoracotomy pain relief.

Methods

Lung cancer patients scheduled for lobectomy via thoracotomy were randomly allocated to receive either PVB-sf or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a 300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative pain was assessed using a visual analog scale (VAS) score at various time points, including the primary endpoint of 2 h after ropivacaine bolus injection. Sensory block area, vital signs, serum ropivacaine concentrations, and side effects were also evaluated.

Results

The Epi group showed significantly lower VAS scores and blood pressure and a wider sensory block area than the PVB-sf group at all evaluation time points. While the mean serum ropivacaine concentration in the PVB-sf group was significantly higher than that in the Epi group until 1 h after injection of the ropivacaine bolus, there was no significant difference at any subsequent assessment point. The incidence of side effects was similar between the groups.

Conclusion

The Epi was superior to PVB-sf for the management of post-thoracotomy pain in this patient cohort. The number of dermatomes anaesthetized by Epi was greater than that anaesthetized by PVB-sf. No difference in complication rates was observed between the two groups.

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Acknowledgments

This study was supported by the Department of Anesthesiology, Nagoya University Graduate School of Medicine.

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Authors and Affiliations

  1. Division of Anesthesia, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan

    Takahiro Tamura & Shuichi Yokota

  2. Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan

    Takahiro Tamura, Yasuyuki Shibata & Kimitoshi Nishiwaki

  3. Division of Thoracic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan

    Shoichi Mori

  4. Department of Perioperative Management System, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Atsushi Mori

  5. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Masahiko Ando

Authors
  1. Takahiro Tamura
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  2. Shoichi Mori
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  3. Atsushi Mori
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  4. Masahiko Ando
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  5. Shuichi Yokota
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  6. Yasuyuki Shibata
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  7. Kimitoshi Nishiwaki
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Corresponding author

Correspondence to Kimitoshi Nishiwaki.

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None of the authors has any conflicts of interest to declare in relation to this work.

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Tamura, T., Mori, S., Mori, A. et al. A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief. J Anesth 31, 263–270 (2017). https://doi.org/10.1007/s00540-017-2307-5

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  • DOI: https://doi.org/10.1007/s00540-017-2307-5

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