ABSTRACT
Chronic thoracic pain is one of the most encountered problem in patients having malignancy.ln addition to drug therapy there are different interventional techniques for management of this pain. The aim of this work is to evaluate the analgesic efficacy of the paravertebral block versus multiple level intercostals block in the management of chronic malignant thoracic pain and to study the radiological spread of the dye in both techniques putting into consideration the effect on the pulmonary function and haemodynamics, and the sympathetic block. This study was conducted in the pain clinic in the National Cancer Institute on 60 patients of both sexes having chronic thoracic pain of malignant origin on oral opioid therapy. The patients were randomly allocated into 2 groups each group 30 patients.Group A received paravertebral single injection, whereas group B received three level intercostals blocK.Each group is further subdivided into 2 subgroups to receive either 8 or 12 ml of bupivacaine 0.25%. The study showed that in group a spread of the dye was to 2-4 intercostal spaces with both epidural and contralateral spread whereas in group B the dye was restricted to each intercostal space. Sympathetic blockade in group A lasted 16-17 hours and was absent in group B. Systolic, diastolic blood pressure and heart rate were the same in both groups. Pulmonary function was moderetly higher in group A. There was low VAS score in group A. Paravertebral is better than intercostals block in response to chronic thoracic pain as the injected drug spread for more than one intercostal space with both epidural and contralateral spread and with sympathetic blockade. Paravertebral technique cannot be used as a sole technique for management of this pain