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Combination of continuous paravertebral block and epidural anesthesia in postoperative pain control after esophagectomy

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Abstract

Background

We conducted paravertebral block (PVB) for thoracotomy, with epidural anesthesia carried out as usual for laparotomy. To date, there has been no report of combining continuous PVB for thoracotomy and epidural anesthesia for laparotomy after esophagectomy. The aim of this historical study was to evaluate the efficacy of the combination.

Methods

This is a retrospective analysis of 105 patients who underwent transthoracic esophagectomy at our institution from April 2012 to July 2014. Fifty-three patients underwent two epidural catheter placements for thoracotomy and laparotomy from April 2012 to March 2013 (EP group), and 52 underwent PVB for thoracotomy and epidural catheter for laparotomy from April 2013 to July 2014 (PVB group). In both groups, an anesthetic agent was continuously infused until postoperative day 7. PVB was placed by the surgical team at the end of the operation under direct vision.

Results

There was no significant difference between the two groups regarding dosage of an additional analgesic agent. Only one catheter-related complication occurred, in the EP group. The frequency of hypotension in the PVB group was significantly lower than that in the EP group (9.6 and 30.2 %, respectively; P = 0.008). The time to ambulation in the PVB group was significantly shorter than that in the EP group (1.5 ± 0.5 days vs. 1.9 ± 0.9 days; P = 0.007).

Conclusions

Combined PVB for thoracotomy and epidural anesthesia for laparotomy is safe and effective. This method should be considered a useful option for postoperative pain control after esophagectomy.

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Ethical Statement

This work conforms to the guidelines set forth in the Helsinki Declaration concerning Human and Animal Rights. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Conflict of interest

All authors declare that they have no conflicts of interest regarding this article.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Yukiko Niwa, Masahiko Koike, Koji Torii, Hisaharu Oya, Naoki Iwata, Mitsuro Kanda, Daisuke Kobayashi, Chie Tanaka, Suguru Yamada, Tsutomu Fujii, Goro Nakayama, Hiroyuki Sugimoto, Shuji Nomoto, Michitaka Fujiwara & Yasuhiro Kodera

Authors
  1. Yukiko Niwa
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  2. Masahiko Koike
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  3. Koji Torii
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  4. Hisaharu Oya
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  5. Naoki Iwata
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  6. Mitsuro Kanda
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  7. Daisuke Kobayashi
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  8. Chie Tanaka
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  9. Suguru Yamada
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  10. Tsutomu Fujii
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  11. Goro Nakayama
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  12. Hiroyuki Sugimoto
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  13. Shuji Nomoto
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  14. Michitaka Fujiwara
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  15. Yasuhiro Kodera
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Corresponding author

Correspondence to Masahiko Koike.

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Niwa, Y., Koike, M., Torii, K. et al. Combination of continuous paravertebral block and epidural anesthesia in postoperative pain control after esophagectomy. Esophagus 13, 42–47 (2016). https://doi.org/10.1007/s10388-015-0487-3

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  • DOI: https://doi.org/10.1007/s10388-015-0487-3

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