Comparison between systemic analgesia, continuous wound catheter analgesia and continuous thoracic paravertebral block

Abstract

Our results support the efficacy of TPVB for pain management after thoracotomy, at rest and after coughing. These results confirm the preference for TPVB over epidural analgesia in postthoracotomy pain care. CWC failed to decrease pain and morphine consumption and performed no better than placebo.

Trends and New Evidence in the Management of Acute and Chronic Post-Thoracotomy Pain—An Overview of the Literature from 2005 to 2015

“…In fact, of all surgical procedures, thoracotomies may create the greatest demand for post-operative analgesia. 1 Even after less invasive techniques, such as video and robotic-assisted thoracoscopic surgery, postoperative pain is of considerable concern. 2 Uncontrolled post-thoracotomy pain has important implications for a patient"s recovery and can add significant morbidity and increase health-care costs.…”

“…In their recent study Dango et al randomized 84 patients undergoing elective open thoracotomies for lung resections to receive TPVB with ropivacaine in combination with IT morphine and sufentanil or TEA with a combination of ropivacaine and sufentanil.22 Pain scores at rest and during coughing were measured at1,2,4,8,12, 24, 48, and 72 hours after the surgery.While pain scores were statistically lower in patients receiving TEA at several observation points, overall differences were small and likely not clinically significant. The authors postulate that combined TPVB with IT opioid administration is a reasonable alternative to TEA for postthoracotomy pain relief.An IT morphine dose of 0.3 mg may provide comparable analgesia to TPVB for post-thoracotomy pain.…”

Anaesthetic considerations for pectus repair surgery

“…Thoracic PVB may be a suitable alternative in thoracotomy patients, where only a unilateral sensory block is desirable (77). Bilaterally inserted PVB (78,79) have been used in paediatric surgical practice.…”

“…Residual pneumothorax requiring chest drain after the operation is quite common (>50% cases) (77), and some experts advocate deep extubation to avoid coughing in these patients (67). …”

“…Management of cardiac injuries may require institution of emergency cardiopulmonary bypass (101). Minor complications include lung trauma, pericardial tears, pleural and pericardial effusion that do not require treatment (77)(78)(79).…”