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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Inadequate pain management after VATS lobectomies has been associated with significant morbidity. Thoracic epidurals (TEAs) have classically been the primary modality for post-operative analgesia. However, they are not without significant complications. We investigated if paravertebral blocks (PVBs) provide non-inferior postoperative analgesia while diminishing patients‘ risk of analgesia-related complications.
Methods We performed an anonymized prospective chart review of 165 patients undergoing VATS lobectomies with a PVB or a TEA at Vancouver General Hospital with local health authority approval. Postoperative pain scores at rest and with activity, and total opioid consumption, were recorded in the PACU, and on postoperative days 0, 1, and 2. The frequency of hemodynamic and respiratory complications, Foley catheterization, nausea, pruritus, and drowsiness were recorded at the same time intervals. Data were analyzed using a linear mixed model. P-values less than 0.05 were considered to be significant.
Results 65 patients received a PVB and 100 patients received a TEA, and the groups did not differ significantly for any studied demographic variable. We did not identify any points in patients’ post-operative courses where pain, at rest and with activity, and total opioid consumption differed significantly between the two patient cohorts. Patients who received TEAs had more complications than those with PVBs, with the greatest differences found in the incidence of hemodynamic complications, pruritis, and Foley catheterization.
Boxplots comparing average pain scores in the PACU, and on POD0, POD1, and POD2 in patients who received either a PVB or a TEA
Bar plots comparing rates of side effects between patients with a PVB and a TEA for each of the seven studied complications (Hemodynamics, Respiratory, Foley Catheter, Pain, Pruritis, NV, and Drowsy)
Conclusions PVBs offer non-inferior analgesia while providing a reduced incidence of analgesia-related complications relative to TEAs in patients undergoing VATS lobectomies. PVBs should thus be considered as an effective analgesic alternative to TEAs in these patients.