COMPARISON BETWEEN THORACIC EPIDURAL AND PARAVERTEBRAL BLOCK TECHNIQUE FOR POSTOPERATIVE ANALGESIA IN THORACOTOMY

Abstract

Objectives: The present study was planned to compare paravertebral block with conventional thoracic epidural technique in terms of efficacy, duration of analgesia, and complications in patients undergoing thoracotomy. Methods: A prospective randomized, double-blinded control study was conducted at King George Hospital adults undergoing thoracotomy between January 2020 and June 2021 after getting permission from the institutional ethical committee and getting consent from the patient. Patients were allocated into two groups by simple random sampling: Group A – patients receiving thoracic epidural anesthesia and Group B – patients receiving paravertebral blocks. The total sample size of the study was 32. Under strictly controlled aseptic conditions, a Tuohy needle was inserted in the midline of the thorax, and the epidural space was verified using the loss of resistance technique. The catheter was secured after being inserted via the needle. The surgeon in Group B inserted a Tuohy needle into the paravertebral space under direct view after the procedure. Results: The age distribution of study subjects in both the groups was similar, and only a minor difference was observed. The difference in mean age between the two groups was not statistically significant (p>0.05); hence, both the groups were comparable. There was a statistically significant difference between the mean MAP between the two groups throughout the postoperative period. There was a statistically significant variation in mean value of in the mean arterial pressure over time as p<0.05. However, this variation in MAP was minimal in subjects who received paravertebral block compared to a statistically significant drop in MAP among subjects who received epidural block. This difference in MAP variation between the two groups was statistically significant. The minor difference in mean PEFR between the two groups was not statistically significant (p>0.05); hence, both the groups were comparable regarding PEFR. Conclusion: From the present study, TPVA and TEA are helpful for pain relief, and the technique selection should depend on the patient profile, clinical scenario, and expertise of the anesthesiologist in the regional approach available.