|
|
Randomized Controlled Phase III Trial of Paravertebral Catheter vs. Epidural Catheter for Post Thoracotomy Pain Control
M. J. Liptay1, Z. T. Hammoud2, E. Merwitz1, J. McGee1, F. Clark1, K. Culiner1. 1Evanston Northwestern Healthcare, Evanston, IL, 2Indiana University, Indianapolis, IN,
BACKGROUND:
Preoperative epidural catheter insertion was compared to a potentially simpler intraoperatively inserted paravertebral catheter for post-thoracotomy pain control.
METHODS:
37 consecutive patients undergoing planned thoracotomy for lung resection were randomized to receive either On Q (Iflo corp) catheter vs preoperative thoracic epidural catheter insertion. Visual Analog Pain Scales and PCA devices were used to assure adequate pain control and the amounts of IV narcotic used were recorded. We compared means of continuous variables between the Epidural group and On-Q group with Student’s t-tests. A p-value<0.05 was considered statistically significant.
RESULTS:
No significant differences between the two groups existed, thoracotomies were performed in all. The Table illustrates the comparison between the Epidural group and On-Q for pain and treatment satisfaction. There were no statistical differences (p-values ranged from 0.060 to 0.960). In general, the epidural group experienced more pain, with mean BPI pain scores 1.4 and 1.2 points higher at 24 and 48 hours, respectively. In addition, the epidural group had more pain on the worst pain measure, with mean score 1.9 and 2.2 points higher at 24 and 48 hours, respectively.No significant complications were noted associated with either catheter use. No difference in length of stays were seen.
CONCLUSIONS:
Intraoperative On-Q paravertebral catheter insertion provides comparable pain relief to the thoracic epidural catheter. Ease of insertion makes it an alternative to routine epidural insertion.
| Variable | Epidural (n=19) | On Q Paravertebral (n=18) | Difference A-B | Difference A vs. B 95% C.I. | p-value (group A vs. B) | | Post-Op Pain Comparisons | | BPI Pain score at 24 hours, 0=no pain, [[Unsupported Character - ⋯]], 10=worst pain | | | | | | | Mean (std) | 3.9 (2.7) | 2.5 (2.0) | 1.4 (2.4) | (-0.1, 3.1) | 0.072 | | | | | | | | | BPI Pain score at 48 hours, 0=no pain, [[Unsupported Character - ⋯]], 10=worst pain (mean, std) | | | | | | | Mean (std) | 3.5 (1.7) | 2.3 (1.4) | 1.2 (2.2) | (-0.3, 2.7) | 0.104 | | | | | | | | | Worst pain at 24 hours, 0=no pain, [[Unsupported Character - ⋯]], 10=worst pain | | | | | | | Mean (std) | 6.3 (3.1) | 4.4 (2.8) | 1.9 (2.9) | (-0.1, 3.8) | 0.062 | | | | | | | | | Worst pain at 48 hours, 0=no pain, [[Unsupported Character - ⋯]], 10=worst pain | | | | | | | Mean (std) | 6.4 (2.9) | 4.2 (3.1) | 2.2 (3.0) | (0.1, 4.1) | 0.037 |
PCA dose administered (n, % yes) | 15 (79%) | 18, (100%) | 0.105 | | | | | | | Number of PCA demands, if PCA administered | | | | | Mean (std) | 20.3 (35.3) | 19.9 (17.7) | 0.962 |
Back to 32nd Annual Meeting
Back to Program Outline
|
