Therapeutics and Clinical Risk Management (Aug 2020)
A Randomized Controlled Trial Comparing Analgesic Efficacies of an Ultrasound-Guided Approach with and without a Combined Pressure Measurement Technique for Thoracic Paravertebral Blocks After Open Thoracotomy
Abstract
Eun Kyung Choi, Ji-il Kim, Sang-Jin Park Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of KoreaCorrespondence: Sang-Jin ParkDepartment of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Hyeonchung-ro, Nam-gu, Daegu, Republic of KoreaTel +82-53-620-3366Fax +82-53-626-5275Email [email protected]: Ultrasound-guided thoracic paravertebral block (TPVB) is an established means for providing postoperative analgesia in thoracic surgery. However, there are conflicting results regarding the efficacy of post-thoracotomy pain management of ultrasound-guided TPVB when compared with that using traditional landmark approach. We therefore conducted a comparative study to evaluate the analgesic efficacy of TPVB when pressure measurement during needle advancement is combined with an ultrasound-guided approach.Patients and Methods: The patients scheduled for lobectomy through thoracotomy were randomly allocated to receive either the ultrasound-guided approach only group (U group) or the ultrasound-guided approach combined with pressure measurement group (UP group) (n = 36 per group). Before thoracic muscle closure, 0.375% ropivacaine (20 mL) was administered as a bolus, followed by a continuous infusion of 0.2% ropivacaine (0.1 mL/kg/hr) in both groups. Postoperative pain was assessed using the visual analogue scale (VAS) pain score while resting and coughing. Local anesthetics and pethidine usage and sensory block area were also evaluated.Results: The UP group showed significantly lower VAS scores, local anesthetics and pethidine usage, and a wider sensory block area than the U group.Conclusion: A combined technique with ultrasound guidance and pressure measurement provided a superior analgesic effect over that of an ultrasound-guided approach alone for the management of post-thoracotomy pain.Keywords: postoperative analgesia, pressure measurement, thoracic surgery, ultrasound-guided, visual analogue scale
