Thoracic epidural versus paravertebral blockade for reducing chronic post-thoracotomy pain (TOPIC-2): open label, parallel group, superiority, multicentre, randomised controlled trial.

In UK adults undergoing thoracotomy, paravertebral blockade did not reduce chronic post-thoracotomy pain at six months versus thoracic epidural (22% vs 16%).

• Why it matters: Chronic post-thoracotomy pain remains a key perioperative outcome, and evidence comparing paravertebral blockade with thoracic epidural is needed to guide analgesic choice.
• What they did: In a multicentre open-label superiority RCT (15 thoracic centres, 2019–2023), 737 modified intention-to-treat patients received either three single-shot paravertebral injections plus catheter or a thoracic epidural catheter loaded with local anaesthetic.
• The result: At six months, adjusted risk ratio was 1.32 (95% CI 0.93 to 1.86; P=0.12), with marginally higher acute pain on day 1 for paravertebral blockade and fewer hypotension and pruritis events, while complications were otherwise similar.

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