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Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind, controlled trial
  1. Lulu Chen1,
  2. Yiquan Wu1,
  3. Yaoyao Cai1,
  4. Yingchao Ye1,
  5. Li Li1,
  6. Yun Xia2,
  7. Thomas J Papadimos3,
  8. Xuzhong Xu1 and
  9. Quanguang Wang1
  1. 1 Department of Anesthesiology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
  2. 2 Department of Anesthesiology, Ohio State University Medical Center, Columbus, Ohio, USA
  3. 3 University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
  1. Correspondence to Quanguang Wang, Department of Anesthesiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; quanguangwang{at}sina.com; Xuzhong Xu, Anesthesiology, theFirst Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; xuzhong{at}263.net

Abstract

Background and objectives In this randomized, double-blind, controlled study, we hypothesized that programmed intermittent bolus infusion (PIBI) of local anesthetic for continuous paravertebral block (PVB), combined with patient-controlled analgesia (PCA), provided better pain control, better patient satisfaction, and decreased in local anesthetic consumption when compared with a continuous infusion (CI) combined with PCA, after video-assisted thoracoscopic unilateral lung resection surgery.

Methods Preoperatively, patients undergoing video-assisted thoracoscopic unilateral lung resection surgery received ipsilateral paravertebral catheters inserted at the level of thoracic vertebrae 4 and 5. All the subjects received an initial bolus of 15 mL 0.375% ropivacaine via the catheters. Subjects were randomized to receive 0.2 % ropivacaine 8 mL/h as either PIBI (n=17) or CI (n=17) combined with a PCA pump. The pain scores, frequency of PCA, local anesthetic consumption, patient satisfaction, and the need for rescue analgesia with tramadol were recorded until 48 hours postoperative.

Results The numeric rating scale scores in the PIBI group were significantly lower than the CI group at 4, 8, 12 hours and 4, 8, 12, 24 hours postoperatively, at rest, and during coughing, respectively. PCA local anesthetic consumption (30 mg (20–60 mg) vs 120 mg (70–155 mg), p=0.000) and frequency of PCA use over 48 hours (3 (2–6) vs 12 (7–15.5), p=0.000) was lower in the PIBI group as compared with the CI group. Additionally, the PIBI group showed greater patient satisfaction. The need for tramadol rescue was similar in the two groups.

Conclusions In PVBs, local anesthetic administered as a PIBI in conjunction with PCA provided superior postoperative analgesia to a CI combined with PCA in patients undergoing video-assisted thoracoscopic unilateral lung resection surgery.

Clinical trial registration ChiCTR-IOR-17011253.

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Footnotes

  • LC and YW contributed equally.

  • Contributors LC, XX, QW: responsible for study design, conduct of the study, data collection, data analysis, and manuscript preparation. YW: participated in conduct of the study, data collection, manuscript preparation, and data analysis. YC, YY, LL: participated in conduct of the study. YX: responsible for study design and data analysis. TJP: participated in revising the manuscript.

  • Funding This work was supported by an item from the Department of Science and Technology of Wenzhou (No. Y20150244).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University and registered in the China Clinical Trial Registry.

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