title: Paravertebral block via the surgical field versus epidural block for patients undergoing thoracotomy: a randomized clinical trial.
abstract: OBJECTIVE
  A paravertebral block (PVB) given via the surgical field can be safer and technically simpler than an epidural block (EP) for postoperative pain control. We conducted this clinical trial to confirm the effectiveness of PVB after thoracotomy.
  
  
  METHODS
  In this non-inferiority trial, patients were randomly assigned to receive PVB (n = 35) or EP (n = 35). The primary endpoint was the pain assessed using the visual analog scale (VAS) at rest, 2, 24, and 48 h after thoracotomy, with the non-inferiority margin set at 15 mm. The secondary end points were the pain assessed using the VAS on exercising and on coughing, 2, 24, and 48 h after surgery, respectively, and the complications and need for additional analgesic agents.
  
  
  RESULTS
  This trial revealed that PVB was not inferior to EP with respect to the primary end point: The mean VAS scores at rest, 2, 24, and 48 h after thoracotomy were 26.3, 10.8, and 8.3 mm in the PVB group and 23.6, 12.4, and 12.6 mm in the EP group, respectively (P < 0.01 for non-inferiority at all points). There were no significant differences between the groups in the incidence of complications or the need for additional analgesic agents.
  
  
  CONCLUSIONS
  PVB may replace EP for postoperative pain control because of its technical simplicity and safety.
authors.affiliation: Department of Thoracic Surgery, Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo 108-0073, Japan. chinosenar@gmail.com
authors.forename: Rei
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Shoichi
authors.initials: S
authors.lastname: Mori
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakai
authors.forename: Koichi
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Saito
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Katayama
authors.forename: Junya
authors.initials: J
authors.lastname: Nakata
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fukui
authors.forename: Simon
authors.initials: S
authors.lastname: Ito
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Abe
authors.forename: Shunzo
authors.initials: S
authors.lastname: Hatooka
authors.forename: Renko
authors.initials: R
authors.lastname: Hosoda
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsudomi
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D013908:Thoracotomy; D013997:Time Factors; D055815:Young Adult