Background. Meta-analysis and systematic reviews of epidural compared with paravertebral
blockade analgesia techniques for thoracotomy conclude that although the analgesia is
comparable, paravertebral blockade has a better short-term side-effect profile. However,
reduction in major complications including mortality has not been proven.
Methods. The UK pneumonectomy study was a prospective observational cohort study in
which all UK thoracic surgical centres were invited to participate. Data presented here
relate to the mode of analgesia and outcome. Data were analysed for 312 patients
having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint
was a major complication.
Results. The most common type of analgesia used was epidural (61.1%) followed by
paravertebral infusion (31%). Epidural catheter use was associated with major
complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P¼0.02) by stepwise
logistic regression analysis.
Conclusions. An increased incidence of clinically important major post-pneumonectomy
complications was associated with thoracic epidural compared with paravertebral
blockade analgesia. However, this study is unable to provide robust evidence to change
clinical practice for a better clinical outcome. A large multicentre randomized controlled
trial is now needed to compare the efficacy, complications, and cost-effectiveness of
epidural and paravertebral blockade analgesia after major lung resection with the
primary outcome of clinically important major morbidity.