title: Safety of the paravertebral block in patients ineligible for epidural block undergoing pulmonary resection.
abstract: OBJECTIVE
  We previously reported the noninferiority of paravertebral block (PVB) to epidural block. In this study, we assessed whether PVB via an intrathoracic approach was also safe for the patients ineligible for epidural block because of, for example, anticoagulation or antiplatelet therapy.
  
  
  METHODS
  Patients admitted to our hospital for pulmonary resection between April 2010 and March 2012, and who were ineligible for epidural block for various reasons, were enrolled in this study. A catheter for PVB was inserted in the operative field by the surgeons just before closing the chest. Ropivacaine of 0.2 % was injected at 4 ml/h using an infuser pump for 5 days. Concurrent use of intravenous patient controlled analgesia (IVPCA) for 2 days with PVB was permitted as a post-operative analgesic at the discretion of anesthesiologists. We estimated the post-operative complications in these patients.
  
  
  RESULTS
  A total of 35 (15.8 %) consecutive patients were enrolled in this study and successfully completed the study protocol. Thirty-two patients received concurrent IVPCA treatment. Post-operative complications due to PVB were not observed, but other complications included 1 incidence of atrial fibrillation, 1 hypertension, 1 pleural fluid accumulation, 1 respiratory failure requiring mechanical ventilation, and 1 of late chest pain requiring intercostal nerve block.
  
  
  CONCLUSIONS
  This study suggests that PVB is safe in patients ineligible for epidural block and can contribute to their pain relief following pulmonary resection procedure including video-assisted thoracic surgery.
authors.affiliation: Department of Cardiovascular and Respiratory Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan. t-katayama@hph.pref.hiroshima.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Katayama
authors.forename: Shinji
authors.initials: S
authors.lastname: Hirai
authors.forename: Rei
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Makoto
authors.initials: M
authors.lastname: Hamaishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okada
authors.forename: Norimasa
authors.initials: N
authors.lastname: Mitsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage; D000075202:Contraindications; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D011013:Pneumonectomy; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine