EXTRADURAL, PARAVERTEBRAL AND INTERCOSTAL NERVE BLOCKS FOR POSTTHORACOTOMY PAIN

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.