Slovenská chirurgia 3 - 4/2021

Use of paravertebralblock in the treatment of postoperative pain after thoracosurgery

Thoracotomy is the basic surgical approach to the thoracic cavity. The pain associated with thoracotomy is considered to be one of the most intense types of postoperative pain. Inadequate postoperative pain management is closely associated to the development of postoperative complications due to insufficient respiratory rehabilitation in the early postoperative period. Postthoracotomic acute pain is multifactorial and it is associated with irritation and damage of intercostal nerves, which are responsible for both: acute and chronic pain after thoracotomy. Their compression with surgical instruments during the procedure as well as their incorporation into postoperative scars leads to a change in pain from nociceptive to neurogenic and neuropathic. Effective treatment of acute pain after thoracotomy then leads to a significant reduction in the risk of developing postoperative complications and also reduces the probability of chronic pain development. Treatment options for thoracotomy pain include traditional treatment with morphine derivatives in combination with non-opioid analgesics, through epidural analgesia, to thoracic paravertebral block. Thoracic epidural analgesia (EDA) is the gold standard for the treatment of postoperative pain after thoracotomy. Due to its serious side effects, especially in the group of patients taking anticoagulants or antiplatelet drugs, it is in many cases contraindicated. Thoracic paravertebral block (PVB) is an alternative treatment modality. The mechanism of action is the blockage of several adjacent thoracic dermatomas above and below the infusion site. Equivalent postoperative analgesia has been demonstrated compared to EDA, but with fewer side effects. In our work, we discuss problems and possibilities of using thoracic paravertebral blockade in the group of patients treated with this modality on 2nd clinic of surgery L. Pasteur University hospital and P. J. Šafárik University, Medical faculty.

Keywords: paravertebral catheter, intercostal space, postoperative analgesia, bupivacaine, thoracotomy