Preoperative Multiple-Injection Thoracic Paravertebral Blocks Reduce Postoperative Pain and Analgesic Requirements After Video-Assisted Thoracic Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 20; no. 5; pp. 639 - 643
• Main Authors: Kaya, Fatma Nur, Turker, Gurkan, Basagan-Mogol, Elif, Goren, Suna, Bayram, Sami, Gebitekin, Cengiz
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2006
• Subjects: Analgesics - administration & dosage; Female; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Nerve Block - methods; Pain Measurement; Pain, Postoperative - prevention & control; postoperative analgesia; Preoperative Care - methods; Prognosis; Prospective Studies; Spinal Nerves; thoracic paravertebral blocks; Thoracic Surgery, Video-Assisted - methods; thoracoscopic surgery; thoracoscopic surgery; postoperative analgesia; thoracic paravertebral blocks
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2006.03.022

Objective:
The hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures.
Design:
Prospective, randomized, controlled, blinded study.
Setting:
Single-university hospital.
Participants:
Fifty consenting patients undergoing video-assisted thoracic surgery.
Interventions:
Patients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25).
Measurements and Main Results:
Intraoperative fentanyl consumption was lower in the PVB group (
p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (
p < 0.05 and
p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (
p < 0.01 for 0 hours and
p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (
p < 0.05 for 12 hours and
p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (
p < 0.05), and first mobilization and hospital discharge were quicker (
p < 0.01 and
p < 0.05, respectively) in the PVB group.
Conclusion:
Perioperative multiple-injection thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.