Systemic analgesia with paracetamol and nonsteroidal anti-inflammatory drugs plus opioids as a rescue medication had reported to be better than that depend mainly on opioids for postoperative pain relief. Thoracic paravertebral block reported to provide a comparable postthoracotomy pain relief to epidural analgesia, with fewer side effects due to its unilateral effect. Thoracic paravertebral catheter can be inserted intraoperatively under direct vision during thoracic surgery (Sabanathan’s technique). This prospective randomized study was designed to evaluate the safety and efficacy of this technique with continuous infusion of lidocaine compared to systemic analgesia for postthoracotomy pain relief. Sixty-three patients were randomized to receive a continuous infusion of lidocaine in the paravertebral catheter for 3 postoperative days (thoracic paravertebral group, n = 32) or systemic analgesia (systemic analgesia group, n = 31). All patients underwent standard posterolateral thoracotomy. There were no significant differences between both groups in age, sex, side, type, and duration of operation. Pain scores measured on visual analogue scale and morphine consumption were significantly lower in thoracic paravertebral group in all postoperative days. Spirometric pulmonary functions were not reaching the preoperative values in the third postoperative day in both groups, but restorations of pulmonary functions were superior in paravertebral group. No complications could be attributed to the paravertebral catheter. Side effects, mainly nausea and vomiting followed by urinary retention, were significantly more in systemic analgesia group (P = 0.03). Also, pulmonary complications were more in systemic analgesia group but not reaching statistical significance (P = 0.14). Continuous paravertebral block by direct access to the paravertebral space using a catheter inserted by the surgeon is a simple technique, with low risk of complications, provides effective pain relief with fewer side effects, and reduces the early loss of postoperative pulmonary functions when compared to systemic analgesia.

中文翻译：

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术中直接入路与全身镇痛相比连续椎旁阻滞对开胸手术后疼痛的缓解

据报道，以扑热息痛和非甾体抗炎药加阿片类药物作为抢救药物的全身镇痛效果要好于主要依靠阿片类药物的术后镇痛效果。据报道胸腔椎旁阻滞可提供与硬膜外镇痛类似的开胸术后疼痛缓解，且由于其单方面作用而副作用较少。可以在胸外科手术中在直视下术中插入胸椎旁导管（Sabanathan技术）。这项前瞻性随机研究旨在评估连续输注利多卡因与全身镇痛相比开胸手术后疼痛缓解的安全性和有效性。六十三名患者被随机分配接受连续3天（胸椎旁椎骨治疗组，n = 32）或全身镇痛（全身镇痛组，n = 31）在术后3天连续输注利多卡因。所有患者均接受标准的后外侧开胸手术。两组在年龄，性别，侧面，类型和手术时间方面均无显着差异。在所有术后天中，胸椎旁组的视觉模拟量表测出的疼痛评分和吗啡消耗量均显着降低。两组在术后第三天肺活量肺功能均未达到术前值，但椎旁组肺功能恢复良好。没有并发症可归因于椎旁导管。副作用，在全身镇痛组中，主要是恶心和呕吐，然后是尿retention留（P = 0.03）。此外，全身镇痛组的肺部并发症更多，但未达到统计学显着性（P = 0.14）。与全身性相比，通过使用外科医师插入的导管直接进入椎旁间隙而连续进行椎旁阻滞是一种简单的技术，并发症风险低，可有效缓解疼痛且副作用少，并减少术后肺功能的早期丧失镇痛。