Paravertebral vs Epidural Anesthesia for Video-assisted Thoracoscopic Surgery: A Randomized Trial

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Pain Management

Background:

• Postoperative pain management after thoracoscopic surgery remains a clinical challenge.
• The efficacy of paravertebral block (PVB) versus thoracic epidural analgesia (TEA) for moderate to severe acute pain is debated.

Purpose of the Study:

• To compare the benefits of paravertebral block (PVB) against thoracic epidural analgesia (TEA) in patients undergoing thoracoscopic surgery.

Main Methods:

• A randomized controlled trial involving 176 patients undergoing thoracoscopic surgery.
• Patients were allocated to either the PVB or TEA group.
• Pain was assessed using the visual analogue scale (VAS) at rest and during coughing.

Main Results:

• No significant difference in VAS scores was observed between the PVB and TEA groups at rest or with coughing.
• PVB demonstrated a significantly shorter median catheter placement time (5 minutes vs. 14 minutes) compared to TEA.
• PVB group showed a lower catheter placement failure rate and reduced incidence of hypotension and urinary retention.

Conclusions:

• Paravertebral block provides comparable pain relief to thoracic epidural analgesia for thoracoscopic procedures.
• PVB offers advantages including reduced procedure time, lower complication rates, and no additional puncture pain compared to TEA.