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

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.