Thoracic paravertebral block versus intrathecal morphine for pain relief after thoracotomy [Torakotomi sonrasi a?ri kontrolünde torasik paravertebral blok ile intratekal morfin uygulamalarlnin karşilaştirilmasi]

Objective: This study aimed to compare the analgesic efficacies of thoracic paravertebral block and intrathecal morphine in patients undergoing posterolateral thoracotomy and lobectomy under general anesthesia. Method: Forty patients, aged 18-65 yrs, undergoing elective lobectomies were randomized into two groups: In the paravertebral block group (PVB, n=20), an epidural catheter was inserted into the paravertebral space by the surgeon before thoracotomy closure; 20 mL 0.25% bupivacaine bolus was given at the end of surgery and 0.25% bupivacaine (0.1 mLkg-1h-1) infusion was given for 24th hour after surgery. In the intrathecal morphine group (UM, n=20), intrathecal 10 µg kg-1 morphine was given at the end of surgery. Patient controlled analgesia using morphine was administered postoperatively for all patients. Systolic and diastolic arterial pressures, heart rate, respiratory rate, oxygen saturation, arterial blood gases, peak expiratory flows and sedation scores were recorded. Results: Demographic data and postoperative hemodynamic, respiratory parameters and pain scores were similar in both groups. Postoperative 24th hour morphine consumption and sedation scores during the initial 4th hour after surgery were higher in the ITM group (p< 0.05), while sedation scores at 12th and 24th hour were similar between groups. Conclusion: Although both techniques were effective in controlling pain after posterolateral thoracotomy, morphine consumption at 24th hour was lower and sedation scores during the initial 4th hour after surgery were improved in patients who were administered a thoracic paravertebral block when compared to patients who were given intrathecal morphine