Objective: To assess the effectiveness of the long acting local anesthetic
(0.25% ropivacaine) intermittently administered through an extrapleural
paravertebral catheter versus a thoracic epidural catheter on postthoracotomy
pain relief
Patients and Methods: Forty patients undergoing elective posterolateral
thoracotomy during the period between July 2001 and August 2002
were prospectively studied. They were randomly allocated into two
groUps (A and B) of 20 patients each. Group A patients received an epidural-
type catheter inserted by the surgeon into art extrapleural pocket extending
for 2 to 3 intercostal spaces both above and below the thoracotomy
incision alongside the vertebral column by the conclusion of operation.
A bolus dose of 15 ml of 0.25% ropivacaine analgesia was given during
chest closure. Group B patients received a thoracic epidural catheter inserted
by the anesthesiologist at T5-6 or T6-7 interspace before induction
of anesthesia. A bolus dose of 15 ml of 0.25% ropivacaine analgesia Was
given after confirming the correct position of the epidural catheter. Postoperatively,
patients in both groups were intermittently administered 25 ml
of 0.25% ropivacaine analgesia at 6 hourly intervals for 3 successive
days. Pain scores (verbal rating scale), requirement of additional analgesia
(P/SAID), pulmonary function test, shoulder range of motion as well as
any complication encountered were assessed and compared in both
groups