Comparison between continuous thoracic epidural block and continuous thoracic paravertebral block in the management of thoracic trauma

Abstract

Background: Postoperative pain is thought to be the single most important factor leading to ineffective ventilation and impaired secretion clearance after thoracic trauma. Effective pain relief can be provided by thoracic epidural analgesia but may have side effects or contraindications. Paravertebral block is an effective alternative method without the side effects of a thoracic epidural. We did this study to compare efficacy of thoracic epidural and paravertebral block in providing analgesia to thoracic trauma patients.

Methods: After ethical clearance, 50 patients who had thoracic trauma were randomized into two groups. One was a thoracic epidural group (25), and second was a paravertebral group (25). Both groups received 10 ml of bolus of plain 0.125% bupivacaine and a continuous infusion of 0.25% bupivacaine at the rate of 0.1 ml/kg/h for 24 h. Assessment of pain, hemodynamic parameters, and spirometric measurements of pulmonary function were done before and after procedure. Visual analog scale (VAS) scores were accepted as main outcome of the study and taken for power analysis.

Results: There was significant decrease in postoperative pain in both the groups as measured by VAS score. However, the degree of pain relief between the groups was comparable. There was a significant improvement in pulmonary function tests in both the groups post-procedure. The change in amount of inflammatory markers between both the groups was not significantly different.

Conclusion: Paravertebral block for analgesia is comparable to thoracic epidural in thoracic trauma patients and is associated with fewer side effects.

Keywords: Advanced trauma life support (ATLS); Continuous thoracic epidural; Thoracic trauma.

Figures

Fig. 1

Study flow diagram.

Fig. 2

Cause of injury (expressed as percentage).

Fig. 3

VAS score comparison between the groups.

Fig. 4

Pulmonary function before and after intervention between the groups.

Fig. 5

Hemodynamic parameters before and after procedure between the groups.