K. Perttunen et al., EXTRADURAL, PARAVERTEBRAL AND INTERCOSTAL NERVE BLOCKS FOR POSTTHORACOTOMY PAIN, British Journal of Anaesthesia, 75(5), 1995, pp. 541-547
Forty-five patients were allocated randomly to receive either a single
intrathoracic block of four intercostal nerves, a continuous thoracic
extradural infusion or a continuous paravertebral infusion of bupivac
aine. Patients were allowed additional i.v. boluses of morphine via a
PCA device. Segmental spread of pinprick analgesia was comparable in t
he groups for up to 20 h. Up to 2 h after the block, plasma concentrat
ions of bupivacaine were greater in the intercostal group and there wa
s large interindividual variation. There were no significant differenc
es between the groups in pain, morphine consumption, respiratory funct
ion or adverse events. Moderate to severe respiratory depression was d
etected in 14 patients more than 2 h after operation.