Año 2017 / Volumen 24 / Número 2

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Comparison of two concentrations of bupivacaine by continuous paravertebral infusion after thoracotomy with pulmonary resection: a double-blind, randomized clinical trial

Rev Soc Esp Dolor 2017; 24(2): 68-73 / DOI: 10.20986/resed.2016.3474/2016

ABSTRACT

Background and objectives: Post-thoracotomy pain management should be based on a multimodal approach that includes continuous regional analgesia. The objective of this study was to compare the analgesic efficacy of two concentrations of bupivacaine

(0.2 % and 0.3 %) through a paravertebral catheter, both group plus fentanyl 2 mcg/ml.

Methods: We conducted a randomized double-blind clinical trial to compare these two concentrations in patients undergoing pulmonary resection by thoracotomy in Donostia University Hospital between November 2010 and May 2011 (n = 59). The paravertebral catheter was placed prior to the surgical intervention, with the patient awake and sitting upright. Data were analyzed on an intention-to-treat basis. The Chi-squared test was used for qualitative variables and Student’s t-tests or Mann-Whitney-Wilcoxon tests for quantitative variables, depending on the distribution of the variables. Statistical analysis was performed using IBM SPSS software (Version 17).

Results: We did not find statistically significant differences in postoperative pulmonary function (p = 0.49), self-perceived pain (VAS; p = 0.28) or cumulative morphine consumption (p = 0.101) in the two groups. We observed adverse effects in 8 patients in group 1 (29.6 %) and in 12 patients (37.5 %) in group 2, the difference not being statistically significant (p = 0.52).

Conclusions: Continuous thoracic paravertebral block for 48 hours is a good technique for the management of postoperative pain after pulmonary resection by thoracotomy. With

moderate doses of local anesthetics (bupivacaine 0.20 %) we achieved good pain control and observed few systemic complications than major doses (bupivacaine 0.30 %).

Key words: Postoperative pain, thoracotomy, paravertebral blockade, analgesia, bupivacaine.

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J. Zabaleta PhD1, B. Mugabure MD2, R. Ortiz de Urbina MD2, L. C. Imaz PhD2, B. Aguinagalde MD1 and J. M. Izquierdo PhD1 1Thoracic Surgery Service. Donostia University Hospital. 2Service of Anesthesia. Acute Pain Unit. Donostia University Hospital. Comparison of two concentrations of bupivacaine by continuous paravertebral infusion after thoracotomy with pulmonary resection: a double-blind, randomized clinical trial. Rev Soc Esp Dolor 2017; 24(2): 68-73 / DOI: 1020986/resed20163474/2016

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