To Block Or Not To Block: Efficacy Of Paravertebral Blocks In Thoracic Surgery Procedures
Amy Roach, David Sisco, Jayson Fitter, Michael Kissen, Gabriel Pollock, Evangeline Rodriguez, Harmik J. Soukiasian, Taryne A. Imai.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
BACKGROUND: Pain control is imperative after thoracic surgery to prevent post-operative complications, such as pneumonia. Regional blocks are used to minimize opiate use and associated side effects. We evaluated the efficacy of paravertebral blocks (PVB) on decreasing morphine milligram equivalents (MME), pain scores, and length of stay (LOS) after surgery.
METHODS: Data was retrospectively collected on patients who underwent various minimally invasive procedures of the chest from February to August 2019. Patients requiring patient-controlled-analgesia, thoracotomy, or intubation were excluded. The PVB group was defined as patients receiving a block on post-operative day 1 and MME were totaled for a 24-hour period after block administration. For the no-block group, MME were totaled within an equivalent 24-hour period. Student's t-test compared average MME, pain scores, and LOS in the PVB versus no-block patients. Sub-group analysis was performed on patients undergoing lung resection. Additional analysis compared thoracoscopic versus robotic surgery patients receiving PVB.
RESULTS: A total of 86 patients met inclusion criteria, with 65% receiving PVB and 69.8% undergoing pulmonary resections (Table 1). For all procedures, there was no difference in averaged total MME amongst the PVB and no-block groups (35 vs 30, p=0.55). There were also no differences in average pain scores (3.5 vs 3.8, p=0.09) and LOS (4.5 vs 4.4, p=0.84). In lung resection patients, there was no difference amongst the PVB and no-block group in average MME (37.4 vs 41.1, p = 0.74), pain score (3.7 vs 3.7, p=0.96), and LOS (4.5 vs 3, p=0.13). Amongst the PVB group, robotic patients demonstrated higher pain scores (4.6 vs 3.2, p<0.05) and total MME (59.6 vs 25.8, p<0.05) than thoracoscopic patients. LOS was not significantly different between the surgical approaches (5.7 vs 3.9, p=0.13).
CONCLUSIONS: Although PVB have the potential to decrease opioid use in post-operative patients, we demonstrate no difference in MME, pain scores, or LOS in patients undergoing minimally invasive thoracic procedures. Randomized control trials are necessary to further investigate and appraise the efficacy of PVB.
LEGEND: Table 1: Minimally Invasive Procedures and Paravertebral Blocks Performed
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