Thoracic Paravertebral Block Versus Intrapleural Analgesia Following Cancer Breast Surgery

Background: The aim of this study was to evaluate the effeciveness of postoperative analgesia of thoracic paravertebral nerve block in comparison to intrapleural analgesia after cancer breast surgery. Methods: The study was carried out on thirty patients subjected to cancer breast surgery . General anesthesia was fixed for all patients as follow: peroxygenation by 100% oxygen for at least 3 minutes. Intravenous 2mg/kg propofol and 80ug/kg vecurounium. Intubation was done under complete muscle relaxation and anesthesia was maintained by a mixture of NO2/02(FiO2=40%) and isoflurane 1-1.5%. Top up dose of vecuronium was one fifth of the initial dose. At the end of surgery and before reversal of muscle relaxation and extubation patients were randomly assigned to one of two groups:GroupI patients received Thoracic paravertebral block(TPVB) at T4. GroupII patients received intrapleural analgesia(IPA). A mixture of local anesthetic (0.3ml/kg ropivacaine0.5%) and 2mg morphine were injected before extubation of the patients to both groups. The duration of analgesia, verbal rating pain score(VRS) values, sedation score, vital sings and adverse effects were recorded. Results: our study showed that TPVB was more effective in postoperative control of pain compared to IPA, has lower VRS scores, less analgesic requirements and longer duration of analgesia. Both techniques showed hemodynamic stability and significant decrease in PH but was within normal physiological range. Conclusion: TPVB has the upper hand in comparison to IPA in pain management , has lower VRS score , less additional analgesic requirements and longer duration of analgesia.