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Comparison of Postoperative Analgesia in Thoracotomy Patients by Thoracic Epidural versus Paravertebral Block with Ropivacaine and Clonidine

Tanmoy Ganguly, Chaitali Sen Dasgupta, Sandeep Kumar Kar, Anupam Goswami, Chiranjib Bhattacharya, Anirban Som, Manasij Mitra, Sandip Sinha

Background: Postoperative pain after thoracotomy is not only responsible for patient’s suffering but also brings about postoperative respiratory complications. The authors compared two techniques as a component of multimodal analgesia in thoracotomy patients: firstly, thoracic epidural which is the gold standard and secondly paravertebral block with the same drug ropivacaine and clonidine.

Methods: 34 adult patients 20 to 60 years of age, ASA status of I & II undergoing elective lateral and posterolateral thoracotomy were included in this study. Exclusion criteria were, patients with any systemic comorbidity and any contraindication to regional anesthesia. Patients were allocated into two groups by computer generated randomisation chart: Group 1 received thoracic epidural analgesia and group 2 received paravertebral analgesia. Parameters recorded were postoperative analgesia by visual analogue scale (VAS) at rest, during deep breathing and during coughing, total rescue analgesic requirement, pH and PaCO2, capillary blood glucose, intraoperative heart rate and blood pressure, extubation time, ICU stay, total hospital stay phenylephrine requirement and incidence of complications.

Result: Analgesia was better in thoracic epidural group for some duration but no persistent effect. Intraoperative heart rate and blood pressure was lower in thoracic epidural group. Total rescue analgesic requirement, pH and PaCO2, capillary blood glucose, extubation time, ICU stay and total hospital stay showed no significant difference. Incidence of bradycardia and phenylephrine requirement was higher in thoracic epidural group.

Conclusion: Although thoracic epidural technique provides better analgesia at some point of time, paravertebral block is preferred because of lower incidence of hypotension, bradycardia and lesser requirement of vasopressor.