Paravertebral continuous block analgesia: from theory to routine^†

We read with interest the paper by Scarfe et al. [1] since we have been committed to prove if paravertebral local analgesia could be the new gold standard in thoracic surgery.

Therefore, we are pleased that our data are consistent with those of one of their literature reviews. We found that paravertebral block (PVB) analgesia in thoracotomy patients presents no contraindications or side effects [2]. Moreover, postoperative pain relief was even more successful than in epidural analgesia. Unfortunately, the Authors found no improvement of pain management in PVB. However, no meta-analysis was conducted, owing to limited data availability and a lack of uniformity in outcome measurement between studies with regard to the use of rescue analgesia and pain scores.

We support their conclusions with our present daily experience. In the last 2 years, we have definitively left epidural analgesia in favour of PVB by a catheter placed through the thoracotomy. Surgeons and anaesthetists achieve success using PVB analgesia at our thoracic surgery unit, because it is not only a safe and successful technique, but it is handy indeed.

These features make PVB very convenient for the anaesthetist who saves time preoperatively and for the surgeon who places the catheter at the end of the surgery in 5 mins.

As we have been satisfied with PVB analgesia, we decided to adopt it also in video-assisted thoracoscopic surgery (VATS) and developed a new technique for catheter placement which is simple and feasible during thoracoscopy [3]. Since in thoracoscopy, the posterior parietal pleura is always kept intact and any drug run-off in the pleural cavity is avoided, PVB in VATS is even more effective than in open surgery.

Prompted by our wish of innovation, we decided to use our VATS technique for paravertebral catheter placement [3] also in thoracotomies, leaving the technique adopted at the beginning [2]. Once again we were satisfied. At present, excluding cases of pleural disease, which is the only contraindication to catheter placement, we always use PVB in both VATS and thoracotomy.

We congratulate the Authors with the hope that their paper could be useful in focusing thoracic surgeons’ attention on this successful analgesia.

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Author notes