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Continuous paravertebral extrapleural infusion for post-thoracotomy pain management
D N Bimston1, J P McGee, M J Liptay
1Department of Surgery, Evanston Hospital, Ill, USA.
Surgery
|October 16, 1999
Summary
Continuous paravertebral infusion offers effective post-thoracotomy pain control, comparable to epidural analgesia by day two. This surgeon-placed method may reduce complications like urinary retention.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pain Management
Background:
- Continuous thoracic epidural analgesia is the standard for post-thoracotomy pain but has complications.
- This study compares continuous paravertebral extrapleural infusion to epidural infusion for post-thoracotomy pain control.
Purpose of the Study:
- To compare the efficacy and safety of continuous paravertebral infusion versus continuous epidural infusion for post-thoracotomy pain management.
- To evaluate postoperative complications associated with each analgesic method.
Main Methods:
- A prospective randomized study of 50 patients undergoing thoracotomy.
- Patients received either paravertebral or epidural infusion for pain control.
- Analgesic efficacy and postoperative complications were assessed.
Main Results:
- Both paravertebral and epidural infusions provided adequate pain control.
- Epidural analgesia showed early superiority, but paravertebral matched it by postoperative day 2.
- Urinary retention was significantly more frequent with epidural catheters; other complications were similar.
- No drug toxicity was observed with either method.
Conclusions:
- Continuous paravertebral infusion is a viable alternative for post-thoracotomy analgesia.
- Surgeon placement and management of paravertebral catheters are feasible.
- Paravertebral infusion may offer an improved safety profile, particularly regarding urinary retention.
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