Pro and Con| Volume 29, ISSUE 6, P1717-1719, December 2015

Pro: Thoracic Epidural Block Is Superior to Paravertebral Blocks for Open Thoracic Surgery

Published:September 16, 2015DOI:
      IT IS WELL KNOWN that a thoracotomy incision is one of the most painful incisions that a patient can experience. Pain control is crucial not only for humanitarian reasons and patient satisfaction, but also for favorable outcomes in patients having open thoracotomy procedures. A wide variety of modalities have been used to control post-thoracotomy pain, including systemic analgesics, cryoanalgesia, intrapleural analgesia, and regional techniques such as intercostal blockade, thoracic epidural analgesia (TEA), and paravertebral block (PVB). TEA long has been considered the gold standard for post-thoracotomy pain relief and has been accepted widely as the analgesic modality of choice for patients undergoing open thoracic procedures.
      • Joshi G.P.
      • Bonnet F.
      • Shah R.
      • et al.
      A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia.
      Paravertebral block, a technique first described by Sellheim more than a century ago, has gained popularity for post-thoracotomy pain control in recent years. Despite this resurgence, TEA remains the most widely used analgesic modality, with 61% of practitioners electing to place a thoracic epidural catheter versus 31% for paravertebral blockade in one study.
      • Powell E.S.
      • Cook D.
      • Pearce A.C.
      • et al.
      A prospective, multicenter, observational cohort study of analgesia and outcome after pneumonectomy.
      In this review, the authors found that TEA remained superior to PVB for open thoracic procedures.

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