Comparing analgesia effect of postoperative thoracic para vertebral block sand intercostal nerve block for unilateral thoracotomy.
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Date
2020-06
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Addis Abeba University
Abstract
Background: Thoracotomy is one of the most painful operative procedures. Ineffective
postoperative pain management practice in this procedure will result in physiological and
psychosocial deterioration which increases the risk of morbidity and mortality. This can be
reduced by ensuring adequate analgesia using multimodal technique with regional blocks. So far
epidural block is the gold standard, intercostal, and paravertebral blocks are the alternatives
which results in somatic and sympathetic blockade of multiple dermatomes and reduce pain.
Objective: To assess the postoperative analgesia effect of postoperative thoracic paravertebral
nerve block (TPVB) and intercostal nerve block (ICNB) for unilateral thoracotomy in Addis
Ababa from December 25, 2019 to April 30, 2020 GC.
Method: A prospective cohort study was conducted on 56 patients who were selected by
systematic random sampling technique from December 25, 2019 to April 30, 2020 GC.Patients
in the paravertebral group received a block by 0.25% bupivacaine at thoracic vertebral level4-7
and those in the intercostal group received a block by 0.25% bupivacaine at thoracic vertebral
level3-8.Data collection was done by perioperative observation and patient interview for 24hour.
The analysiswas done by independentt-test, Mann Whitney U test for parametric and
nonparametricquantitative variables respectively; Fisher’s exact testor chi square test for
qualitative variablesP<0.05 was considered statistically significant.
Result:In this study, the median postoperative pain score at 24hr was lower by a paravertebral
group with a significant difference at 6 and 8hr of the block both at rest p=0.036, 0.004and on
coughing p=0.024, 0.004 respectively as compared with an intercostal group. The time elapsed to
first analgesic request was longer in the paravertebral group 10hr than an intercostal group 6hr
with p<0.001. Total tramadoland morphine consumption in 24hr was significantly lower in the
paravertebral group with p0.036 and 0.002 respectively.
Conclusion and recommendation:Thoracic paravertebral block done at the end of unilateral
thoracotomy decrease postoperative pain, total analgesic consumption and prolong first analgesic
request time than an intercostal block. Based on these postoperative thoracic paravertebral block
is recommended to be a technique of choice for pain management of unilateral thoracotomy.
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Keywords
Post-thoracotomy pain and analgesia, intercostal block, paravertebral block