ULTRASOUND GUIDED THORACIC PARA VERTEBRAL BLOCK VS EPIDURAL ANALGESIA FOR POST-THORACOTOMY PAIN RELIEF AND IMPROVING RESPIRATORY FUNCTION

Background and objectives: Thoracic epidural block is considered by many as the method of choice for control of post-thoracotomy pain. Ultrasound guided thoracic paravertebral block is a recent technique which may offer several advantages. We therefore evaluated the analgesic effects of both bocks. Methods: We randomized 30 patients undergoing elective thoracotomy to two groups: thoracic epidural group (TED) and ultrasound guided thoracic paravertebral group (TPV). During early postoperative 72 h, we measured pain intensity, intravenous fentanyl consumption by patient controlled analgesia pump, spirometric tests, arterial blood gas analysis and complications. Results: Analgesic quality was comparable in both groups with a higher consumption of fentanyl in ultrasound guided TPV group. Spirometric tests were comparable between both groups except forced vital capacity and forced expiratory volume in one second at 24h which was more favorable in TED group. Values of vital parameters (SpO2%, respiratory rate, heart rate and mean arterial blood pressure) were comparable in both groups. Perforation of the pleura was reported in one patient who belongs to the TPV group. Conclusion: TPVB is a suitable alternative to epidural analgesia for pain management following thoracotomy and it can provide proper anesthesia and analgesia in patients with severe co-morbidities and contraindications to neuroaxial blocks... Despite the use of ultrasound guided, puncture of the pleura is still a possible complication.