Objective

Thoracic epidural block (TEB) and Paravertebral block (PVB) are used in many surgical specialties for post-operative pain relief and in the management of multiple rib fractures. It is believed, but not proven, that PVB is superior to TEP in preserving the ribs and chest wall motion. Here we explore the effect of these invasive procedures on chest wall motion.

Methods

Structured Light Plethysmography (SLP) was used to measure chest wall mechanics for 16 patients who had TEB (n=3), PVB (n=5) or intravenous analgesia (control group) (n=8) after thoracic surgery via video assisted thoracotomy (VATS) or thoracotomy. Chest wall motion measurements were done during quiet breathing before surgery and day 1 after.

Results

The changes in overall chest wall motion one day after surgery was not significant between the three groups, 5 +/- 4 %, 11 +/- 29% and 8 +/- 11 % in TEB group, PVB group and Control groups respectively (p 0.34). The motion of the operated side was reduced in all groups but this reduction was similar between the groups, -8 +/- 15%, -17 +/- 13% and -16 -/+ 21% in TEB group, PVB group and control groups respectively (p 0.21). The motion of the non-operative side was similar in all groups (Table 1).

Conclusion

Contrary to common belief, our data is the first data to prove that post-operative epidural block has no negative effect on chest wall motion in comparison to the control and the paravertebral groups. This fact has a wide range of clinical implications.