• Pain physician · Sep 2021

    Randomized Controlled Trial

    Efficacy of Single-shot Thoracic Paravertebral Block Combined with Intravenous Analgesia Versus Continuous Thoracic Epidural Analgesia for Chronic Pain After Thoracotomy.

    • Xiu-Liang Li, Jie Zhang, Lei Wan, and Jing Wang.
    • Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
    • Pain Physician. 2021 Sep 1; 24 (6): E753-E759.

    BackgroundPatients undergoing thoracic surgery frequently suffer from chronic pain after thoracotomy. Chronic pain can lead to a significant decline in a patient's quality of life. However, the effect of single-shot thoracic paravertebral block (TPVB) combined with intravenous analgesia on chronic pain incidence is unclear.ObjectiveThe objective was to evaluate the impact of single-shot TPVB combined with intravenous analgesia versus continuous thoracic epidural analgesia (TEA) on chronic pain incidence after thoracotomy.Study DesignA randomized controlled study.SettingHospital department in China.MethodsNinety-six patients undergoing thoracotomy were randomly assigned to 2 groups: single-shot TPVB combined with intravenous analgesia (Group P) and continuous TEA (Group E). The pain intensity was assessed using the Verbal Rating Scale (VRS). The outcome measures were chronic pain incidence and the acute and chronic pain intensity.ResultsThe chronic pain incidence at rest in Group P was significantly higher than that in Group E at 3 months and 12 months postoperation  (55.2% versus 28.6%, P = 0.019; 34.5% versus 14.3%, P = 0.027). The patients in Group E showed less pain intensity at rest compared with those in Group P at 3 months postoperation (0.0 versus 1.0, P = 0.034). At 6 hours and 24 hours postoperation, the acute pain intensity at coughing and at rest in Group E was lower than that in group P (VRS at coughing: 6 hours: 0.0 versus 2.0, P = 0.001; 24 hours: 3.0 versus 5.0, P = 0.010. VRS at rest: 6 hours: 0.0 versus 2.0, P = 0.000; 24 hours: 1.0versus. 2.0, P = 0.001).LimitationsAn important limitation of this study is that it is not a double-blind study.ConclusionsIn patients undergoing thoracotomy, continuous TEA significantly reduced the chronic pain incidence at rest at 3 months and 12 months after operation and provided better acute pain relief up to 24 hours after operation compared with single-shot TPVB combined with intravenous analgesia.

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