Clinical outcome of pain management in paravertebral block and continuous intercostal nerve block for post-thoracotomy pain
Journal Title: International Archives of Integrated Medicine - Year 2019, Vol 6, Issue 3
Abstract
Introduction: Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the ‘gold standard’ for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management. Aim of the study: To compare paravertebral block and continuous intercostal nerve block after thoracotomy. Materials and methods: Fifty adult patients undergoing elective posterolateral thoracotomy were randomized to receive either a continuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessed for 48 hours. Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals. Results: With respect to the objective visual assessment (vas), both techniques were effective for post-thoracotomy pain. The average vas score at rest was 29±10 mm for paravertebral block and 31.5±11 mm for continuous intercostal nerve block. The average vas score on coughing was 36±14mm for the first one and 4 ±14 mm for the second group. Conclusion: Thoracic epidural analgesia or nerve blocks are so far considered as the best option but one needs to consider personnel and equipment resources available. A combination of local anesthetics along with opioids can be given to reduce the agony of the patient and early discharge from the hospital.
Authors and Affiliations
Pon. A. Rajarajan
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