Comparison of Intrapleural with Paravertebral Levobupivacaine Analgesia for Thoracoscopic Sympathectomy: A Randomized Controlled Study.

BACKGROUND: Palmar hyperhidrosis is a benign disease of excessive sweating in the palm that exceeds the physiological state. Thoracoscopic sympathectomy is an effective surgical treatment for localized hyperhidrosis. AIMS: The aim of this study was to compare paravertebral block (PVB) with intrapleural analgesia in thoracoscopic sympathectomy. SETTINGS AND DESIGN: A total of 90 patients physical status American Society of Anesthesiologists Classes I or II scheduled for arthroscopic thoracoscopic sympathectomy were enrolled in this study. SUBJECTS AND METHODS: Patients were randomly allocated into three groups; in the controlled (C) group, no regional block was performed. In the intrapleural (I) group or paravertebral (P) group using a volume of 20 ml of levobupivacaine 0.5%. The first request for analgesia postoperatively was our primary concern. Secondary outcomes included pain scores, the cumulative consumption of fentanyl during the 1st postoperative day, pulmonary functions, blood gases, and complications. STATISTICAL ANALYSIS USED: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA). RESULTS: First request of analgesia in paravertebral group was statistically significantly longer when compared with either control or intrapleural group. In addition, total fentanyl dose was significantly higher in control group when compared with the other groups. Groups I and P showed statistically significant less pain scores, better pulmonary function, and blood gases when compared with control group. CONCLUSION: We concluded that either intrapleural or paravertebral analgesia compared with control group in thoracoscopic sympathectomy resulted in later request of analgesia, improved pain control, reduced analgesic requirements postoperatively, preservation of lung function and acid-base balance. The PVB, compared to intrapleural, had an advantage of longer and effective analgesia.