British Journal of Anaesthesia, Vol 75, Issue 4 405-408, Copyright © 1995 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. Richardson, S. Sabanathan, A. J. Mearns, R. D. Shah and C. Goulden
We have undertaken a prospective, randomized comparison of the
superficially similar techniques of interpleural and paravertebral
(extrapleural) analgesia in 53 patients undergoing posterolateral
thoracotomy. Local anaesthetic placed anterior to the superior
costotransverse ligament and posterior to the parietal pleura produces a
paravertebral block and instilled between the parietal and visceral pleurae
produces an interpleural block. Patients received preoperative and
postoperative continuous bupivacaine paravertebral blocks in group 1 and
interpleural blocks in group 2. Premedication comprised diclofenac and
morphine, and after operation all patients had regular diclofenac and
patient-controlled morphine (PCM). Analgesia was assessed by visual
analogue pain scores (VAS), PCM requirements, ratio of preoperative to
postoperative spirometric values (PFT), rates of postoperative respiratory
morbidity (PORM) and hospital stay, all recorded by blinded observers.
Eight patients were withdrawn and data from 45 patients were analysed.
Patient characteristics, surgery, VAS scores and PCM use were similar in
both groups. PFT were significantly better (P = 0.03-0.0001) in group 1,
and PORM was lower and hospital stay approximately 1 day less in this
group. Five patients in group 2 became temporarily confused, probably
because of bupivacaine toxicity (P = 0.02). We conclude that bupivacaine
deposited paravertebrally produced greater preservation of lung function
and fewer side effects than bupivacaine administered interpleurally.
CLINICAL INVESTIGATIONS
A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery
Departments of Anaesthetics and Thoracic Surgery, Bradford Royal Infirmary, Bradford BD9 6RJ
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