Analgesic management with bilateral thoracic paravertebral catheter in patient who underwent bilateral video-assisted thoracoscopic surgery

Objective: In this case report we emphasized the analgesic effect of bilateral thoracic paravertebral catheter in a patient who underwent bilateral video-assisted thoracoscopic surgery (VATS) due to bilateral lung cyst hydatid. Case Report: Bilateral VATS was planned for a forty-year-old ASA 2 female patient due to bilateral cyst hidatic. Initially thoracic epidural catheter (TEC) insertion was thought for postoperative pain management due to bileteral VATS procedure. During the TEC procedure vasovagal syncope and hypotension occured and 5 mg ephedrine was given for hypotension. Paravertebral catheter was inserted at left 2.5-3 cm lateral to the 4th thoracic vertebra level by using 18 Gauge Touhy needle. 10 ml 0.375% bupivacaine was administered preoperatively. Same procedure was performed for right VATS. Patient controlled 400 mg tramadol was administered during postoperative 24 hours. A hundred mg oral tramadol twice a day and paracetamol 500 mg every 6 hours were given on the second day. Eight ml 0.25 % bupivacaine was also administered every 8 hours via both paravertebral catheter for 2 days. Total tramadol consumption was 356 mg and no additional analgesic was required during postoperative 48 hours. Conclusion: Bilateral thoracic paravertebral block could be a safe and good alternative to central neural blocks in case of the diffuculty and contrindications of thoracic epidural blocks.