Comparison of Single-Injection and Multiple-Injection Thoracic Paravertebral Block in Preventing Pain after Video-Assisted Thoracoscopic Surgery

Abstract

Deniz Turan, Fatma Ulus, Serdar Epozdemir, Ali Alagoz

Aim: In our study, we aimed to compare the effect of single and multiple thoracic paravertebral block (TPVB) patients who underwent video assisted thoracoscopic surgery (VATS) on hemodynamic parameters, postoperative visual analog scale (VAS) and sedation scores, and total analgesic consumption.

Materials and Method: The ASA II-III, age between 18 to 65 years, and body mass index lower than thirty, 60 patients who underwent elective VATS were included to this study. Patients were divided into two groups as single (Group S), (n:30) and multiple (Group M), (n:30) TPVB. Block was performed at T6 level in Group S and at T4, T6, T8 levels in Group M by using 21 mL 0.5 % bupivacaine. Intravenous patient-controlled analgesia (PCA) was performed for both groups after surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), Ramsay sedation score (RSS), tramadol consumption during 24 hours, resting and coughing VAS scores were recorded before PCA and at 30th, first, second, 6th, 12th, 20th, and 24th hours of postoperative periods. 50 mg iv dexketoprophene was administered when coughing VAS score above the 4. Despite the iv dexketoprophene, in case of consistent pain 1 gr iv paracetamol was given to the patients, and all additional analgesic requirement was recorded.

Results: Hemodynamic parameters were similar in both groups during postoperative period (p>0.05). VAS scores were higher in Group M but there were not statistically significant (p>0.05). Additional analgesic requirement was significantly higher in Group M, (p>0.04). Cumulative tramadol consumption was comparable between the groups, (p>0.05).

Conclusion: In TPVB, it was observed that single and multiple injections provided similar postoperative pain scores and postoperative cumulative tramadol consumption, but we observed a high additional analgesic requirement in multiple injection group. Based on this result, we concluded that there would be no need to disturb patient comfort and prolong the procedure by applying multiple injections.

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