• David J Daly and Paul S Myles.
• Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Australia. dalyd@alfred.org.au
• Curr Opin Anaesthesiol. 2009 Feb 1; 22 (1): 38-43.

Purpose Of ReviewTo consider optimal analgesic strategies for thoracic surgical patients.Recent FindingsRecent studies have consistently suggested analgesic equivalence between paravertebral and thoracic epidural analgesia. Complications appear to be significantly less common with paravertebral analgesia.SummaryThere is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy. Important side-effects such as hypotension, urinary retention, nausea, and vomiting appear to be less frequent with paravertebral block than with thoracic epidural analgesia. Paravertebral block is associated with better pulmonary function and fewer pulmonary complications than thoracic epidural analgesia. Importantly, contraindications to thoracic epidural analgesia do not preclude paravertebral block, which can also be safely performed in anesthetized patients without an apparent increased risk of neurological injury. The place of paravertebral block in video-assisted thoracoscopic surgery is less clear.

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