Comparison of continuous thoracic epidural block and continuous thoracic paravertebral block for management of post thoracotomy pain: a randomised trial

Aim: Pain after thoracotomy is one of the most severe in clinical practice and more effective analgesia can be achieved by combining systemic and regional techniques. Though thoracic epidural analgesia (TEA) is the gold standard in the treatment, its application can be restricted due to side effects and contraindications. We investigated the hypothesis that thoracic paravertebral block (TPVB) reduced morphine consumption, pain scores, and side effects as much as TEA after thoracotomy. Material and Method: Fifty patients who underwent elective posterolateral thoracotomy were included in this study. Patients were randomly allocated into two groups as TEA (group I, n = 25) and TPVB (group II, n = 25). Postoperative consumption of patient-controlled morphine, visual analog scores (VAS), hemodynamic parameters, and side effects were collected in 72 hours. Additionally, pulmonary function tests (PFT) values were recorded. Results: Postoperative VAS values during rest were comparable between the groups (p > 0.005) and they did not have significantly difference postoperative VAS values during coughing (p > 0.005). The cumulative morphine consumption was higher in Group 2 (p < 0.05). Side effects were comparable between the groups II (p > 0.05). Conclusion: We conclude that TEA provided more effective analgesia than TPVB in thoracotomy patients in the early postoperative period with comparable side effects.