Authors: Imran M et al.
Cureus 17(10): e95807, October 2025. DOI: 10.7759/cureus.95807
This retrospective cohort study compared thoracic paravertebral block (PVB) with thoracic epidural analgesia (TEA) in 380 adults undergoing open thoracotomy at a tertiary cardiothoracic center. The goal was to assess real-world effectiveness and safety within an Enhanced Recovery After Surgery (ERAS) framework, focusing on dynamic pain control during the first 48 hours and key complications such as hypotension and urinary retention.
Dynamic pain scores improved in both groups but were modestly lower with PVB at 24 and 48 hours (TEA: 5.8→4.8; PVB: 5.1→4.2). The adjusted differences (–0.6 and –0.5, respectively) indicated non-inferior analgesia compared with TEA, as both remained below the one-point minimal clinically important difference. However, PVB demonstrated a markedly better safety profile — the composite endpoint of hypotension or urinary retention occurred in 27.6% of TEA patients versus 14.1% of those receiving PVB (adjusted odds ratio 0.44). Opioid consumption, postoperative nausea, pulmonary complications, ICU admissions, and length of stay were all similar between groups.
The findings indicate that while analgesic efficacy between PVB and TEA was clinically equivalent, PVB offered substantially fewer adverse effects. This supports adopting PVB as the preferred default in ERAS thoracotomy protocols, particularly in patients where hemodynamic stability is critical.
What You Should Know:
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PVB achieved non-inferior dynamic pain control versus TEA after thoracotomy.
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Safety outcomes strongly favored PVB, with fewer cases of hypotension and urinary retention.
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Opioid use and other recovery metrics were comparable between groups.
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ERAS protocols emphasizing early mobility and hemodynamic stability may benefit from prioritizing PVB.
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These findings reinforce a shift toward simpler, safer regional techniques in real-world thoracic surgery care.
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