Date of this Version


Document Type

DNP Project





Background: Thoracic Epidural Analgesia (TEA) is currently the gold standard analgesia in adult thoracic surgical patients. TEA has medical complications like sepsis, neurological injury, spinal hematoma, and dural puncture. TEA is also contraindicated for patients with existing neurological or hematological comorbidities including patients under antiplatelet or anticoagulation therapy. These factors not only reduce the scope of administering TEA but also increase the risks of hemodynamic instability like hypotension and bradycardia. PVB can decrease medical complications, side effects, and increase patient satisfaction.

Aim: This quality improvement project aims to compare if PVB is more effective than TEA in terms of patient satisfaction, hemodynamic stability, and usage of opiates for pain management after thoracic surgery in adult patients.

Results: The study was done using 15 journal articles across a range of time to collect evidence from practice to inform clinical research and decisions on PVB usage. The results showed that PVB was more useful than TEA in managing pain. PVB improved the utilization and effectiveness of opiates, reduced side effects, improved hemodynamic stability, and supported better satisfaction amongst patients than TEA administration.

Discussion: The quality improvement project concluded that PVB has less risk of complications than TEA. PVB has certain risks of complications due to an incorrect or erroneous injection method and lack of knowledge of the anesthesia provider administering the PVB. Combining PVB with fentanyl can improve the duration of analgesia and experience of pain. Conclusion: PVB is safer for patients undergoing thoracic surgery than patients undergoing TEA and pain is equally or more efficacious in the management of pain


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