Comparing analgesia effect of postoperative thoracic para vertebral block sand intercostal nerve block for unilateral thoracotomy.

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Addis Abeba University


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.



Post-thoracotomy pain and analgesia, intercostal block, paravertebral block