. (2011) A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy. British Journal of Anaesthesia, Vol.106 (No.3). pp. 364-370. ISSN 0007-0912

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Abstract

Background Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven. Methods The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication. Results The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P=0.02) by stepwise logistic regression analysis. Conclusions An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Lungs -- Surgery, Paravertebral anesthesia
Journal or Publication Title:	British Journal of Anaesthesia
Publisher:	Oxford University Press
ISSN:	0007-0912
Date:	March 2011
Volume:	Vol.106
Number:	No.3
Page Range:	pp. 364-370
Identification Number:	10.1093/bja/aeq379
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	ACTA, ECATA
References:	1. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth 2006;96(4):418-26. 2. Joshi GP, Bonnet F, Shah R, , et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008;107(3):1026-40. 3. Powell ES , Cook D, Davies P , Bishay E, Bowler G, Gao F and UKPOS Co-ordinators. . UK pneumonectomy outcome study (UKPOS): a prospective observational study of pneumonectomy outcome Journal of Cardiothoracic Surgeons 2009 4;41 4. Daly DJ, Myles PS. Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol 2009;22(1):38-43. 5. Luyet C, Eichenberger U, Greif R, Vogt A, Szucs Farkas Z, Moriggl B. Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study. Br J Anaesth 2009;102(4):534-9.
URI:	http://wrap.warwick.ac.uk/id/eprint/42427

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