Abstract
Purpose
The study aims to compare the analgesic efficacy of two analgesic interventions, continuous paravertebral (PVB) nerve block alone with continuous paravertebral and intercostal nerve block (PVB/ICB) in patients undergoing thoracotomy.
Methods
A total of 70 patients undergoing thoracotomy were randomly enrolled in either continuous paravertebral nerve block (PVB) group or in continuous paravertebral and intercostal nerve block (PVB/ICB) group and received corresponding blocks. Analgesic efficacy measured by Visual Analog Scale (VAS) pain score, hemodynamic effects, total narcotic consumption, sedation score, patient’s length of stay in hospital and patient’s satisfaction with the analgesic technique were recorded.
Results
Demographic characteristics of the patients were similar in both groups. The mean VAS pain score was not statistically significant in both groups at 24 h. The mean pulse rate and blood pressures were comparable in both groups for the first 24 h. Nalbuphine consumption was significantly higher in PVB group as compared to PVB/ICB group at 1 h (p = 0.01), 6 h (p = 0.03) and 12 h (p = 0.009) and 24 h (p = 0.03). The mean total nalbuphine consumption in the PVB group was higher (28.29 mg vs. 22.63 mg) and statistically significant then PVB/ICB group (p = 0.03). The total tramadol consumption as a rescue analgesic was higher in the PVB group (131.42 mg) as compared to PVB/ICB group (120 mg) after 24 h but not statistically significant (p = 0.17).
Conclusion
Continuous paravertebral nerve block with intercostal nerve block provides effective post-operative pain relief after thoracotomy with reduced narcotic consumption compared to continuous paravertebral nerve block alone.
Clinical trial registration number
Clinicaltrails.gov NCT04715880.
Similar content being viewed by others
References
Fibla JJ, Molins L, Mier JM, Sierra A, Vidal G. Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%. Eur J Cardiothorac Surg. 2008;33:430–4.
Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin. 2005;15:105–21.
Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008;26:355–67.
Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology. 1994;81:737–59.
Soto RG, Fu ES. Acute pain management for patients undergoing thoracotomy. Ann Thorac Surg. 2003;75:1349–57.
Bong CL, Samuel M, Ng JM, Ip-Yam C. Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2005;19(6):786–93.
Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995;82:1474–506.
Yeung JH, Gates S, Naidu BV, Wilson MJ, Smith FG. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.
Perttunen K, Nilsson E, Heinonen J, Hirvisalo EL, Salo JA, Kalso E. Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain. Br J Anaesth. 1995;75:541–7.
Brase CH, Brase CP. Understandable statistics: concepts and methods. 11th ed. Cengage Leaming: Stamford; 2015.
Gulbahar G, Kocer B, Muratli SN, et al. A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg. 2010;37(2):467–72.
Ng A, Swanevelder J. Pain relief after thoracotomy: is epidural analgesia the optimal technique? Br J Anaesth. 2007;98:159–62.
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy–a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96:418–26.
Senard M, Deflandre EP, Ledoux D, et al. Effect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy. Br J Anaesth. 2010;105:196–200.
Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg. 2005;80:1550–9.
Ouerghi S, Frikha N, Mestiri T, Smati B, Mebazaa MS, Kilani T, Ben Ammar MS. A prospective, randomised comparison of continuous paravertebral block and continuous intercostal nerve block for post-thoracotomy pain. South Afr J Anaesth Analg. 2008;14:19–23.
Carabine UA, Gilliland H, Johnston JR, McGuigan J. Pain relief for thoracotomy. Comparison of morphine requirements using an extrapleural infusion of bupivacaine. Reg Anesth. 1995;20:412–7.
Barron DJ, Tolan MJ, Lea RE. A randomized controlled trial of continuous extra-pleural analgesia post-thoracotomy: efficacy and choice of local anaesthetic. Eur J Anaesthesiol. 1999;16:236–45.
Sabanathan S, Mearns AJ, Bickford Smith PJ, et al. Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics. Br J Surg. 1990;77:221–5.
Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95(3):771–80.
Elsayed H. Insertion of paravertebral block catheters intraoperatively to reduce incidence of block failure. Interact Cardiovasc Thorac Surg. 2012;14(5):648–9.
Karmakar MK, Chung DC. Variability of a thoracic paravertebral block. Are we ignoring the endothoracic fascia? Reg Anesth Pain Med. 2000;25:325–7.
Delilkan AE, Lee CK, Yong NK, Ganendran A. Post-operative local analgesia for thoracotomy with direct bupivacaine intercostal blocks. Anaesthesia. 1973;28:561–7.
Williams BA, Neumann KJ, Goel SK, Wu CL. Postoperative pain and other acute pain syndromes. In: Raj’s practical management of pain. Amsterdam: Elsevier; 2008. p. 299–334.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflict of interest and it is disclosed at end of manuscript.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
About this article
Cite this article
Kumar, S., Hameed, M., Shehzad, R. et al. The comparison of the analgesic efficacy of continuous paravertebral block alone compared with continuous paravertebral and intercostal nerve block for thoracotomy in adults: a randomized controlled trial. J Anesth 37, 923–929 (2023). https://doi.org/10.1007/s00540-023-03255-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-023-03255-8