COMPARISON BETWEEN CONTINUOUS THORACIC EPIDURAL BLOCK AND CONTINUOUS THORACIC PARAVERTEBRAL BLOCK FOR THORACOTOMY PAIN RELIEF

Pain from thoracotomy incision is considered to be severe and intense. The provision of pain relief has been crucial in decreasing morbidity due to pulmonary complications and attenuating the stress response. Many clinical studies concluded that thoracic epidural analgesia was superior to intercostal, interpleural, and I.V. opioids analgesia after thoracotomy. However, recent interest has reemerged in the management of thoracotomy pain by paravertebral nerve block. The current study compared the effect of continuous thoracic epidural and continuous thoracic paravertebral techniques on thoracotomy pain relief using the local anesthetic Ropivacaine. The study was performed on 50 adult consecutive patients (aged 18 years) of both sex, ASA II-III who where admitted for elective lung resection (lobectomy or pneumonectomy). All patients had continuous infusion of ropivacaine 0.375% started immediately after general anesthesia at a rate of (0.1ml/kg/hr) and maintained for 24 hours postoperative. Results should that continuous thoracic paravertebral analgesia was as effective as continuous thoracic epidural analgesia in terms of pain relief after thoracotomy. Both techniques were similar in local anesthetic and postoperative opiate consumption, while paravertebral analgesia provided better preservation of respiratory functions, less neuroendocrine response to surgery, and a reduction in complications.