PMID- 30789665
OWN - NLM
STAT- MEDLINE
DCOM- 20200824
LR  - 20200824
IS  - 1526-4637 (Electronic)
IS  - 1526-2375 (Linking)
VI  - 20
IP  - 9
DP  - 2019 Sep 1
TI  - Persistent Postsurgical Pain Following Thoracotomy: A Comparison of Thoracic 
      Epidural and Paravertebral Blockade as Preventive Analgesia.
PG  - 1796-1802
LID - 10.1093/pm/pny293 [doi]
AB  - OBJECTIVE: Persistent postsurgical pain (PPP) is common following thoracotomy. 
      Thoracic epidural (TEB) and paravertebral blockade (PVB) are both established 
      forms of perioperative analgesia for thoracotomy. There is currently a lack of 
      data on their influence on PPP; this study aims to evaluate both techniques on 
      PPP. DESIGN: Observational study, prospectively collected data. METHODS: Adults 
      who underwent thoracotomy had either TEB or PVB for analgesia and were 
      prospectively interviewed at six months. A numerical rating scale, the short form 
      of the Leeds Assessment of Neuropathic Symptoms and Signs, and the EuroQol-5 
      dimension (EQ-5D) index were used to assess pain, neuropathic pain, and quality 
      of life. RESULTS: Eighty-two patients who underwent a thoracotomy were recruited 
      (TEB N = 36, PVB N = 46). Pain scores had a median (interquartile range [IQR]) of 
      1 (0 to 4.5) and 1.5 (0 to 4, P = 0.89), presence of PPP was 58.3% (95% 
      confidence interval [CI] = 40.0-74.5%) and 60.9% (95% CI = 45.4-74.9%, P = 0.81), 
      and presence of neuropathic pain was 30.6% (95% CI = 16.3-48.1%) and 28.2% (95% 
      CI = 16.0-43.5%, P = 0.85). Reported quality of life was 0.71 (0.14-0.85) and 
      0.80 (0.19-0.91, P = 0.21). Patients who had PPP reported worse quality of life 
      measures compared with those who were pain free, with a median (IQR) EQ-5D index 
      of 0.69 (-0.15 to 0.85) and 0.85 (0.72 to 1, P = 0.0007); quality of life was 
      worst when there was a neuropathic component (median = 0.39, IQR = -0.24 to 
      0.75). CONCLUSIONS: There was no statistical difference in the development of 
      persistent postsurgical pain between patients who received a TEB or a PVB; 
      however, patients who developed PPP had a significantly lower quality of life, 
      which was worse with a neuropathic component.
CI  - (c) Crown copyright 2019.
FAU - Wong, Jonathon
AU  - Wong J
AD  - Department of Perioperative Medicine, Barts Heart Centre and St. Bartholomew's 
      Hospital, London, UK.
FAU - Cooper, Jackie
AU  - Cooper J
AD  - William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, 
      Queen Mary University of London, London, UK.
FAU - Thomas, Rik
AU  - Thomas R
AD  - Department of Perioperative Medicine, University College London Hospital, London, 
      UK.
FAU - Langford, Richard
AU  - Langford R
AD  - Department of Perioperative Medicine, Barts Heart Centre and St. Bartholomew's 
      Hospital, London, UK.
FAU - Anwar, Sibtain
AU  - Anwar S
AD  - Department of Perioperative Medicine, Barts Heart Centre and St. Bartholomew's 
      Hospital, London, UK.
AD  - William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, 
      Queen Mary University of London, London, UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - England
TA  - Pain Med
JT  - Pain medicine (Malden, Mass.)
JID - 100894201
SB  - IM
MH  - Adult
MH  - Aged
MH  - Analgesia, Epidural/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nerve Block/*methods
MH  - Pain Management/*methods
MH  - Pain, Postoperative/*prevention & control
MH  - Thoracotomy/*adverse effects
OTO - NOTNLM
OT  - Chronic Pain
OT  - Paravertebral Block
OT  - Persistent Postsurgical Pain
OT  - Thoracic Epidural
OT  - Thoracotomy
EDAT- 2019/02/23 06:00
MHDA- 2020/08/25 06:00
CRDT- 2019/02/22 06:00
PHST- 2019/02/23 06:00 [pubmed]
PHST- 2020/08/25 06:00 [medline]
PHST- 2019/02/22 06:00 [entrez]
AID - 5355349 [pii]
AID - 10.1093/pm/pny293 [doi]
PST - ppublish
SO  - Pain Med. 2019 Sep 1;20(9):1796-1802. doi: 10.1093/pm/pny293.