Year : 2012  |  Volume : 15  |  Issue : 4  |  Page : 264--265

Invited Commentary


Yatin Mehta 
 Medanta Insititute of Critical Care and Anaesthesiology, Gurgaon, Haryana, India

Correspondence Address:
Yatin Mehta
Medanta Insititute of Critical Care and Anaesthesiology, Medanta, The Medicity Sector 38, Gurgaon, Haryana
India




How to cite this article:
Mehta Y. Invited Commentary.Ann Card Anaesth 2012;15:264-265


How to cite this URL:
Mehta Y. Invited Commentary. Ann Card Anaesth [serial online] 2012 [cited 2023 Jan 29 ];15:264-265
Available from: https://www.annals.in/text.asp?2012/15/4/264/101860


Full Text

El-Morsy et al., [1] in a well-conducted randomized blinded prospective study, compared paravertebral block (PVB) with thoracic epidural analgesia (TEA) in pediatric patients undergoing thoracotomy. The authors found higher failure rate and complications like nausea, vomiting, hypotension, and urinary retention with TEA, but other parameters were comparable. These findings are similar to those of our previous studies in adult patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) [2] and in robotic assisted coronary artery bypass surgery. [3]

PVB is an old technique, [4] but has not become very popular after thoracotomy as compared to TEA, intercostal nerve block, [5] or interpleural block [6] despite lower incidence of complications. In earlier studies, PVB was performed blindly mostly by loss of resistance technique; [7],[8] but in the present paper, the authors used a nerve stimulator for PVB and ultrasound for performing TEA. Utilization of these techniques would certainly reduce the failure rate of these techniques of blocks while probably reducing the complications. The complications of PVB are few like intercostal vessel puncture with subsequent hematoma/hemothorax, [9] pain at the site of puncture, [10] and pleural/lung puncture with resultant pneumothorax. [11],[12],[13],[14] In the present series there was no incidence of pneumothorax, but after a thoracotomy that is really not significant. Apparently, PVB has far lesser complications than TEA.

Although multiple paravertebral injections have been used for post-thoracotomy pain, [9],[15] continuous paravertebral infusion of bupivacaine or ropivacaine with or without fentanyl is the preferred method and has been used in many studies [16],[17] and provides satisfactory and comparable analgesia. [7] Great advances in pain management have occurred in the last 20 years. Patient outcomes in thoracic surgery, including postoperative mobility, duration of hospital stay, atelectasis, pneumonia, and chronic pain syndrome, may be directly related to pain. [18] Given that there is no significant difference in analgesia with PVB compared to TEA as also shown in this study, PVB should be considered in much larger number of patients than it is done at present. [19] PVB should be used post-thoracotomy whenever possible and, in my opinion, we as anesthesiologists are as much responsible for analgesia as for anesthesia.

References

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3Mehta Y, Arora D, Sharma KK, Mishra Y, Wasir H, Trehan N. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery. Ann Card Anaesth 2008;11:91-6.
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