Continuous Paravertebral Analgesia versus Continuous Epidural Analgesia after Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial

Abstract

Background: Whether continuous thoracic epidural analgesia (TEA) and continuous paravertebral block (PVB) have similar analgesic effects in patients undergoing videoassisted thoracic surgery (VATS) lobectomy was compared in this study. Methods: In all, 86 patients undergoing VATS lobectomy were enrolled in the prospective, randomized clinical trial. Group E received TEA. Group P received PVB. The primary endpoint was postoperative 24-hour visual rating scale (VAS) on coughing. Side effects and postoperative complications were also analyzed. Results: Pain scores at rest or on coughing at 24 and 48 h postoperatively were significantly lower in group E than in group P (P <0.05). At 24 h postoperatively, more patients in group E suffered from vomiting (32.6% vs 11.6%, P = 0.019), dizziness (55.8% vs 12.9%, P = 0.009), pruritus (27.9% vs 2.3%, P = 0.002), and hypotension (32.6% vs 4.7%, P = 0.002) than those in group P. Patients in group E were more satisfied (P = 0.047). Four patients in group P and two patients in group E suffered from pulmonary complications (P >0.05). The length of hospital and intensive care unit (ICU) stays were not significantly different. Conclusions: Though TEA has more adverse events than PVB, it may be superior to PVB in patients undergoing VATS lobectomy.

Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians—A Narrative Review

“…In patients with rib fractures, the paravertebral block is more effective for pain control than systemic opioid therapy [71]. After video-assisted thoracoscopic lobectomy for lung cancer, however, continuous paravertebral analgesia had significantly higher pain scores at rest and while coughing at 24 and 48 h than an epidural approach [72]. The PVB anesthetizes spinal nerves emerging from intervertebral foramina and produces unilateral, segmental, somatic, and sympathetic nerve block.…”