Ultrasound guided Thoracic Paravertebral block for postoperative analgesia after thoracotomy, single level or multiple levels, does it matter?

Abstract

Adequate postoperative pain control may help to minimize postoperative pulmonary complications by enabling earlier ambulation and improving the patient's ability to take deep breaths. Thoracic paravertebral block (TPVB) is a compartment block; success relies on spread of injected local anesthetic (LA) within the paravertebral space. This block anesthetizes spinal nerves. Patients and methods;The patients were divided into two group, In Group I: T5 was defined using high frequency linear probe and the corresponding paravertebral space, a Total of 20 ml of Bupivacine 0.25% were injected. In Group II: T4, T5, T6 and T7 were confirmed and 5 ml of of Bupivacine 0.25% were injected in each. 1 ug/kg of fentanyl up to a total of 200 ug and Paracetamol 1 gm were given whenever there is a dramatic change in the hemodynamics with surgical stimulus. At the end, the Pain score were recorded as well as 6 hr, later and the analgesic given. no difference in the median for pain score among the patients 1(1.5) vs 1(1.3) for group I and II respectively), there was a significant reduction in the adjuvant analgesic in group II. 6 hr postoperatively, the median was 5(2.7) vs 2(1.9) only for group II, with a significant statistical reduction in the intensity of pain and the use of postoperative analgesic among the group II. Conclusion; Multiple injection in paravertebral block is more efficient in controlling pain rather than single level injection.