title: Comparison of the analgesic effects of continuous extrapleural block and continuous epidural block after video-assisted thoracoscopic surgery.
abstract: METHODS
  A prospective, randomized, open study. The regional technique used was not blinded.
  
  
  METHODS
  A university teaching hospital.
  
  
  METHODS
  Forty-eight patients undergoing video-assisted thoracoscopic surgery (VATS) for tumor resection.
  
  
  METHODS
  Patients received either continuous extrapleural block or continuous epidural block using ropivacaine for a period of 60 hours after surgery.
  
  
  RESULTS
  To evaluate postoperative pain control, the primary and secondary endpoints were the visual analog scale (VAS) on movement and the amount of rescue analgesia, respectively. There were no significant differences between the extrapleural and epidural block groups with regard to VAS at rest and during movement assessed at 4, 12, 24, 36, and 48 hours after surgery, dosage of intravenous morphine (extrapleural: 12.9 ± 11.3, epidural: 10.2 ± 6.9 mg), supplemental nonsteroidal anti-inflammatory drugs, incidence of postoperative nausea and vomiting (extrapleural: 12/20, epidural: 11/20), postoperative ambulation (extrapleural: 18 at postoperative day [POD] 1 and 20 at POD 2, epidural: 19 at POD 1 and 20 at POD 2) and hospital stay after surgery (extrapleural: 12.7 ± 6.3, epidural: 12.6 ± 4.7 days).
  
  
  CONCLUSIONS
  Although this study did not show the superiority of continuous extrapleural block relative to continuous epidural in VATS patients, the results suggest that both methods provided effective analgesia with a relatively small dose of rescue morphine. Although the analgesic effects of these techniques were comparable, extrapleural block has the advantage of safety and precise placement of the catheter and can be considered an alternative to epidural block in VATS patients.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan. hottak@jichi.ac.jp
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Hotta
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Endo
authors.forename: Koki
authors.initials: K
authors.lastname: Taira
authors.forename: Naho
authors.initials: N
authors.lastname: Sata
authors.forename: Soichiro
authors.initials: S
authors.lastname: Inoue
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Norimasa
authors.initials: N
authors.lastname: Seo
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000379:methods*; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000628:therapy*; D010880:Piperidines / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D000077208:Remifentanil; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
chemical_list: D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil