Cardiothoracic & vascular anesthesia
Thoracic epidural versus paravertebral blockade for reducing chronic post-thoracotomy pain (TOPIC-2): open label, parallel group, superiority, multicentre, randomised controlled trial
Authors' conclusion
Paravertebral blockade did not reduce chronic post-thoracotomy pain at six month follow-up compared to thoracic epidural. Thoracic epidural provided marginally better acute pain relief one day after the operation, but showed no difference thereafter. Postoperative complications were comparable between groups. The findings support the ongoing use of both techniques.
Study context
- Population
- Adult patients undergoing thoracotomy at thoracic centres in the UK, between January 2019 and September 2023enrolled, 428 (56%) male, mean (SD) age 66.6 (11.0) years, 33 exclusions after randomisation of patients who did not proceed to thoracotomy, 737 in the modified intention-to-treat population
- Participants
- 770 patients
- Comparison
- Paravertebral blockade versus thoracic epidural during the perioperative period
- Paravertebral groupn = 364
- Epidural groupn = 373reference
- Primary endpoint
- Incidence of chronic post-thoracotomy pain (100 mm visual analogue score greater than or equal to 40 mm, indicating moderate pain, considering worst chest pain over the past week)
- Follow-up
- Six months after randomisation
Methodological detailsweb based service, 15 thoracic centres in the UK, modified intention-to-treat population
- Web based service
- 15 thoracic centres in the UK
- Modified intention-to-treat population
Primary result
As reported in the abstract
Each group vs epidural groupAdjusted risk ratio (95% CI)P value
Paravertebral group
1.32(0.93–1.86)
P = 0.12Each group vs epidural groupAdjusted risk difference (95% CI)P value
Paravertebral group
0.05(−0.01 to 0.11)
P = 0.12Secondary outcomes
| Outcome | Estimate | |
|---|---|---|
| Acute pain (visual analogue score of 100 mm) · day 1Paravertebral groupvs Epidural groupGreater with paravertebral blockade | adjusted mean difference, worst pain 7.7 mm (95% CI 2.8–12.5) | |
| Acute pain (visual analogue score of 100 mm) · day 1Paravertebral groupvs Epidural groupGreater with paravertebral blockade | adjusted mean difference, average pain 7.0 mm (95% CI 2.7–11.2) | |
| −5051015Difference, mm (linear scale) |
Acute pain (visual analogue score of 100 mm) · day 1
- Worst and average pain no different on days 2-3
Safety
| Outcome | Paravertebral group | Epidural group | Adjusted risk ratio (95% CI) | |
|---|---|---|---|---|
| Hypotension | 12% | 18% | 0.66 (0.46–0.94) | |
| Pruritis | 4% | 12% | 0.37 (0.21–0.64) | |
| Urinary retention | 12% | 6% | 2.21 (1.35–3.61) | |
| 0.20.5125Adjusted risk ratio (log scale) |
| Outcome | Adjusted risk difference (95% CI) | |
|---|---|---|
| HypotensionLess common in the paravertebral group | −0.06 (−0.11 to −0.01) | |
| PruritisLess common in the paravertebral group | −0.07 (−0.11 to −0.03) | |
| Urinary retentionMore participants in the paravertebral group | 0.05 (0.01–0.09) | |
| −0.15−0.1−0.0500.050.1Difference (linear scale) |
Other complications
- Complications were similar otherwise
Original publication
Thoracic epidural versus paravertebral blockade for reducing chronic post-thoracotomy pain (TOPIC-2): open label, parallel group, superiority, multicentre, randomised controlled trial. BMJ. Published 5 November 2026. doi:10.
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