Continuous paravertebral block as an analgesic method in thoracotomy

Rabanal Llevot, Jose Manuel; Fayad Fayad, Mounir; Bartolomé Pacheco, María José; Carceller Malo, Jose María; Naranjo Gómez, Sara; Ortega Morales, Javier

doi:10.1016/S2173-5077(10)70006-5

Información del artículo

Resumen

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Estadísticas

Abstract

Introduction

Open thoracotomy is one of the surgical procedures that is still very painful in the postoperative period, which, in this type of surgery can have on respiratory function and subsequent recovery of the patient.

Patients and method

The aim of the study is to assess continuous paravertebral thoracic block as an analgesic technique in thoracotomy. A total of 139 patients undergoing pulmonary resection surgery by posterolateral thoracotomy received postoperative analgesia using a 1.5% lidocaine infusion (7–10ml/h) through a thoracic paravertebral catheter for at least 48h. Pain intensity measured on the visual analogue scale (VAS) both at rest (passive VAS) and during stimulated cough (active VAS) was recorded at time of discharge from the Recovery Unit, and on the second, third and fourth day post-surgery. Postoperative complications and the need for analgesic rescue were studied.

Results

On discharge from recovery, 98.6% of the patients had mild pain (passive VAS <3), 1.4% had moderate pain (passive VAS 4–6) and none with severe pain (EVA >6); on the 2nd day post-surgery, 97.9% had mild pain, and 1.2% moderate pain; on the third day 98.6% had mild pain and 0.7% moderate pain; and on the 4th day 100% had mild pain. There were no complications arising from the analgesic technique.

Conclusions

Continuous thoracic paravertebral analgesia is effective and safe in controlling post-thoracotomy pain.

Keywords:

Postoperative period

Analgesia thoracic surgery

Postoperative complications

Conduction anaesthesia

Paravertebral block

Local anaesthetic

Lidocaine

Resumen

Introducción

La toracotomía abierta es uno de los procedimientos quirúrgicos con postoperatorio más doloroso, hecho que en este tipo de cirugía puede repercutir sobre la función respiratoria y posterior recuperación del paciente.

Paciente y método

El propósito del estudio es evaluar el bloqueo paravertebral continuo torácico como técnica analgésica en la toracotomía. Ciento treinta y nueve pacientes sometidos a cirugía de resección pulmonar mediante toracotomía posterolateral recibieron analgesia postoperatoria mediante infusión de lidocaína al 1,5% (7–10ml/h) a través de un catéter paravertebral torácico y durante un mínimo de 48h. La intensidad del dolor mediante la escala analógica visual (EVA) tanto en reposo (EVA pasivo) como durante la tos incentivada (EVA activo) fue registrada al alta de la unidad de reanimación, al segundo, tercer y cuarto día postoperatorio. Se estudiaron las complicaciones postoperatorias y la necesidad de analgesia de rescate.

Resultados

Al alta de reanimación un 98,6% de los pacientes presentaron un dolor leve (EVA pasivo < 3), un 1,4% dolor moderado (EVA pasivo 4–6) y 0% un dolor severo (EVA > 6); en el 2.° día postoperatorio un 97,9% tuvieron un dolor leve, y un 1,2%, dolor moderado; en el 3.er día un 98,6%, un dolor leve, y un 0,7%, dolor moderado; y al 4.° día un 100% presentaron dolor leve. No se encontraron complicaciones derivadas de la técnica analgésica.

Conclusiones

La analgesia paravertebral torácica continua es efectiva y segura en el control del dolor postoracotomía.

Palabras clave:

Periodo postoperatorio

Analgesia cirugía torácica

Complicaciones postoperatorias

Anestesia de conducción

Bloqueo paravertebral

Anestésico local

Lidocaína

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