title: Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery.
abstract: OBJECTIVE
  The hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures.
  
  
  METHODS
  Prospective, randomized, controlled, blinded study.
  
  
  METHODS
  Single-university hospital.
  
  
  METHODS
  Fifty consenting patients undergoing video-assisted thoracic surgery.
  
  
  METHODS
  Patients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25).
  
  
  RESULTS
  Intraoperative fentanyl consumption was lower in the PVB group (p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (p < 0.05 and p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (p < 0.01 for 0 hours and p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (p < 0.05 for 12 hours and p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (p < 0.05), and first mobilization and hospital discharge were quicker (p < 0.01 and p < 0.05, respectively) in the PVB group.
  
  
  CONCLUSIONS
  Perioperative multiple-injection thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Medical School, Bursa, Turkey. fnurk@uludag.edu.tr <fnurk@uludag.edu.tr>
authors.forename: Fatma Nur
authors.initials: FN
authors.lastname: Kaya
authors.forename: Gurkan
authors.initials: G
authors.lastname: Turker
authors.forename: Elif
authors.initials: E
authors.lastname: Basagan-Mogol
authors.forename: Suna
authors.initials: S
authors.lastname: Goren
authors.forename: Sami
authors.initials: S
authors.lastname: Bayram
authors.forename: Cengiz
authors.initials: C
authors.lastname: Gebitekin
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D013127:Spinal Nerves; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
chemical_list: D000700:Analgesics