Paravertebral Catheter Use for Postoperative Pain Control in Patients After Lung Transplant Surgery: A Prospective Observational Study

Published:August 18, 2016DOI:


      Effective postoperative pain management has been shown to be a positive predictive factor for postoperative recovery following a thoracotomy. The primary objective of this study was to examine the efficacy and safety of continuous paravertebral blockade in managing acute postsurgical pain following unilateral and bilateral single-lung transplantation.


      The authors conducted a prospective observational trial of patients.


      The study was conducted in an academic university hospital.


      Patients (≥18 years of age) who underwent either unilateral or bilateral single-lung transplantation and received a postoperative paravertebral catheter.


      Paravertebral catheters were placed via an ultrasound-guided technique on either postoperative day 1 or 2. After placement, a continuous infusion of 0.2% ropivacaine was run at 0.2 to 0.25 mL/kg/h with maximum dose of 7 mL/h per side in bilateral lung transplant patients, and 14 mL/h in unilateral lung transplant patients.

      Measurements and Main Results

      Patients were followed up to 120 hours after placement of catheters, and pain scores, opioid use, and adverse events were recorded. There were 35 patients who completed the study from October 2013 to December 2014 (21 bilateral transplants and 14 unilateral transplants). The mean time to paravertebral catheter placement was 1.14 days in the overall group, with median time to extubation occurring 543 minutes after placement (range, 23-2,985 minutes). Catheters remained in place for a mean of 7.18 days. The mean maximal pain scores for both groups was 5.94 (day 1), 6.26 (day 2), 6.20 (day 3), 5.12 (day 4), and 5.60 (day 5). There were no adverse events related to the paravertebral catheters in either group.


      Paravertebral catheters provide a feasible option for postoperative pain control following unilateral or bilateral single-lung transplant in adult patients. Future research should focus on randomized trials of thoracic epidurals compared to paravertebral catheters.

      Key Words

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        • Wright E.C.
        Transverse sternothoracotomy.
        Chest Surg Clin N Am. 1996; 6: 149-156
        • Macchiarini P.
        • Le Roy Ladurie F.
        • Cerrina F.
        • et al.
        Clamshell or sternotomy for double lung or heart–lung transplantation?.
        Eur J Cardiothorac Surg. 1999; 15: 333-339
        • Kehlet H.
        • Holte K.
        Effect of postoperative analgesia on surgical outcome.
        Br J Anaesth. 2001; 87: 62-72
        • Senturk M.
        • Ozcan P.E.
        • Talu G.K.
        • et al.
        The effects of three different analgesia techniques on long-term postthoracotomy pain.
        Anesth Analg. 2002; 91: 11-15
        • Cason M.
        • Naik A.
        • Grimm J.C.
        • et al.
        The efficacy and safety of epidural-based analgesia in a case series of patients undergoing lung transplantation.
        J Cardiothorac Vasc Anesth. 2015; 29: 126-132
        • Feltracco P.
        • Barbieri S.
        • Milevoj M.
        • et al.
        Thoracic epidural analgesia in lung transplantation.
        Transplant Proc. 2010; 42: 1265-1269
        • Joshi G.P.
        • Bonnet F.
        • Shah R.
        • et al.
        A systematic review of randomized trials evaluating regional techniques for post-thoracotomy analgesia.
        Anesth Analg. 2008; 107: 1026-1040
        • Davies R.G.
        • Myles P.S.
        • Graham J.M.
        A comparison of the analgesic efficacy and side effects of paravertebral vs. epidural blockade for thoracotomy—A systematic review and meta-analysis of randomized trial.
        Br J Anaesth. 2006; 96: 418-426
        • Soto R.G.
        • Fu E.S.
        Acute pain management for patients undergoing thoracotomy.
        Ann Thorac Surg. 2003; 75: 1349-1357
        • Mordant P.
        • Bonnette P.
        • Puyo P.
        • et al.
        Advances in lung transplantation for cystic fibrosis that may improve outcome.
        Eur J Cardiothorac Sur. 2010; 38: 637-643
        • Pottecher J.
        • Falcoz P.-E.
        • Massard G.
        • Dupeyron J.-P.
        Does thoracic epidural analgesia improve outcome after lung transplantation?.
        Interact Cardiovasc Thorac Surg. 2011; 12: 51-53
        • Moen V.
        • Dahlgren N.
        • Irestedt L.
        Severe neurological complications after central neuraxial blockades in Sweden 1990-1999.
        Anesthesiology. 2004; 101: 950-959
        • Powell E.S.
        • Cook D.
        • Pearce A.C.
        • et al.
        A prospective, multicenter, observational cohort study of analgesia and outcome after pneumonectomy.
        Br J Anaesth. 2011; 106: 364-370
        • Elsayed H.
        • McKevith J.
        • McShane J.
        • et al.
        Thoracic epidural or paravertebral catheter for analgesia after lung resection: Is the outcome different?.
        J Cardiothorac Vasc Anesth. 2012; 26: 78-82
        • Grider J.S.
        • Mullet T.W.
        • Saha S.P.
        • et al.
        A randomized, double-blind trial comparing continuous thoracic epidural bupivacaine with and without opioid in contrast to a continuous paravertebral infusion of bupivacaine for post-thoracotomy pain.
        J Cardiothor Vasc Anesthes. 2012; 26: 83-89
      1. Yeung JHY, Gates S, Naidu BV, et al: Paravertebral block versus thoracic epidural for patients undergoing thoracotomy (Review). Cochrane Database Syst Rev 2:CD009121, 2016

      2. GlobalRPH, The Clinician’s Ultimate Reference. Opioids - Equianalgesic Dosages. Available at: Accessed June 2015

        • Richard Girard F.
        • Ferraro P.
        • et al.
        Acute postoperative pain in lung transplant recipients.
        Ann Thorac Surg. 2004; 77: 1951-1955
        • Girard F.
        • Chouinard P.
        • Boudreault D.
        • et al.
        Prevalence and impact of pain on the quality of life of lung transplant recipients.
        Chest. 2006; 130: 1535-1540
        • Fortier S.
        • Halim H.A.
        • Alain B.
        • et al.
        Comparison between systemic analgesia, continuous wound catheter analgesia and continuous thoracic paravertebral block: a randomized, controlled trial of postthoracotomy pain management.
        Eur J Anaesth. 2012; 29: 524-530
        • Helms O.
        • Mariano J.
        • Hentz J.G.
        • et al.
        Intra-operative paravertebral block for postoperative analgesia in thoracotomy patients: a randomized, double-blind, placebo-controlled study.
        Eur J Cardiothorac Surg. 2011; 40: 902-906
        • Teeter E.G.
        • Kumar P.A.
        Pro: Thoracic epidural block is superior to paravertebral blocks for open thoracic surgery.
        J Cardiothorac Vasc Anesth. 2015; 29: 1717-1719
        • Krakowski J.C.
        • Arora H.
        Con: Thoracic epidural block is not superior to paravertebral blocks for open thoracic surgery.
        J Cardiothorac Vasc Anesth. 2015; 29: 1720-1722