Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial

Abstract

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies. The trial was prospectively registered at the Australian New Zealand Clinical Trial Registry (https://www.anzctr.org.au/; ACTRN12616000900415; 07 July 2016).

Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study

“…Only a few studies have presented the alleviation of persistent postoperative pain due to regional anesthesia techniques [ 20 , 21 , 22 ]. In these studies, the paravertebral block or the epidural anesthesia reduced chronic pain intensity in patients after a thoracotomy or breast surgery.…”

“…This inventory is multi-dimensional and covers many aspects of chronic pain. We used the NPSI in our previous studies for persistent pain measurement [ 17 , 22 ]. Moreover, NPSI were used by other authors to measure persistent postoperative pain [ 24 , 25 , 26 ].…”

The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review

“…Epidural block showed the greatest tendency for reduction in chronic postoperative pain while other modalities, including continuous wound infiltration and intercostal nerve block, were less efficacious [19, 31]. Previous studies investigating paravertebral blocks have suggest that they provide efficacy equivalent to epidural for management of thoracic surgical pain, and paravertebral blocks may also reduce the incidence and/or intensity of chronic postoperative pain [27, 32, 33].…”

Low dose intraoperative ketamine infusion with multilevel paravertebral block for pain after video-assisted thoracic surgery: a randomized-controlled study

“…Results from previous studies have confirmed the effectiveness of TPVB in acute post-thoracotomy pain control (42,43). Borys et al compared between TPVB and preemptive bolus ketamine in patients undergoing posterolateral thoracotomies and reported that TPVB was superior to ketamine in reducing pain intensity and morphine consumption (44). Ketamine has only moderate effect on acute postoperative pain (36,40), therefore, its advantage is less likely to be shown when combined with other multimodal analgesia techniques (25,45,46).…”