Prolonged paravertebral analgesia for pain relief in patients after thoracotomy

M.M. Synytsyn

Abstract


Background. Thoracotomy refers to one of the most traumatic interventions in surgery, which is accompanied by severe acute pain after surgery and the development of chronic pain syndrome in a remote postoperative period. The aim of the work was to compare the efficacy and safety of different methods of pain control after thoracotomy. Materials and methods. 85 patients after thoracotomy were divided into three study groups. Analgesia was performed with prolonged paravertebral analgesia (PVA) (19 patients) and prolonged epidural analgesia (EDA) (36 patients) with a 0.2% solution of ropivacaine at a rate of 6 ml/h (in the paravertebral or epidural space). In the control group (30 patients), analgesia was performed by an intravenous, patient-controlled analgesia solution of morphine. As an adjuvant analgesic in all three study groups, non-steroidal anti-inflammatory drug ketorolac tromethamine was used intramuscularly. In the early postoperative period, the level of pain at rest and during physical exertion of the respiratory muscles (performance of spirometry), parameters of the spirometry, as well as the frequency and type of complications of the used anesthesia methods were assessed. In the late postoperative period, the incidence of chronic pain was assessed. Results. In groups with PVA and EDA, the intensity of the pain syndrome over the three days of the postoperative period on the visual analogue scale (VAS) was less than in the control group. In the PVA group, the pain level was from 29.1 points four hours after the operation to 18.7 points at the end of the third day; in the EDA group — from 24.2 points to 20.3 points, respectively; in the control group — from 48.8 points to 38.0 points, respectively. During the spirometry study, the pain intensity in the PVA and EDA groups was also lower in comparison with the control group and was 3.8 points, 38.7 points and 61.2 points, respectively. The incidence of chronic pain was assessed 6 months after surgery. 15 patients were selected from each group. In the control group, chronic pain syndrome developed in 8 patients (53 %), in the EDA group — in 5 patients (33.3 %), in the PVA group — in 3 patients (20 %). The least number of complications and technical failures was observed in the PVA group. Conclusions. In the PVA group, in comparison with the EDA group, the pain level by VAS was lower, the incidence of chronic pain was less, and the number of side effects was minimal. Prolonged paravertebral blockade in patients after thoracotomy makes it possible to effectively control acute postoperative pain and reduces the development of chronic pain syndrome.

Keywords


thoracotomy; prolonged paravertebral analgesia; regional anesthesia

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DOI: https://doi.org/10.22141/2224-0586.2.81.2017.99708

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