title: Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery.
abstract: BACKGROUND
  Appropriate postoperative analgesia is crucial in fast-track surgery, which is a multimodal therapeutic strategy that aims toward enhanced postoperative recovery and shortened hospital stay. Paravertebral block (PVB) has been reported to be as effective as thoracic epidural blockade (TEB), but PVB is not often employed for video-assisted thoracoscopic surgery (VATS) for 2 reasons. First, TEB is still the gold standard for thoracic surgery, and second, thoracoscopic insertion of a PVB catheter is challenging.
  
  
  METHODS
  In this retrospective observational study, 185 patients who underwent VATS and thoracoscopic paravertebral catheterization were analyzed. Postoperatively, the patients were continuously administered a local anesthetic (0.5% bupivacaine hydrochloride or 0.2% ropivacaine hydrochloride). Additionally, they were given an oral non-steroidal anti-inflammatory drug (NSAID) as needed. Intramuscular/intravenous pentazocine was administered as a rescue medication. The effect of pain control was measured in terms of the frequency of NSAID taken orally and the necessity for a rescue drug on postoperative days (POD) 0, 1, 2, and 3.
  
  
  RESULTS
  The mean age of the 185 patients included in the study was 67 years (Confidence Interval: 66-69). The mean frequency of NSAID use was 0.67 (0-3), 1.59 (0-4), 1.43 (0-4), and 1.33 (0-4) on POD 0, 1, 2, and 3, respectively. 32 (17.3%) and 3 patients (1.6%) were administered a rescue medication on POD 0 and 1, respectively. The most common postoperative complication was nausea/vomiting, which occurred in 17 patients (9.1%).
  
  
  CONCLUSIONS
  PVB may greatly contribute to enhanced recovery after thoracic surgery owing to effective analgesia and fewer side effects.
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. Electronic address: tk.thoracic@gmail.com.
authors.forename: Teruya
authors.initials: T
authors.lastname: Komatsu
authors.affiliation: Department of Anesthesiology, Nagara Medical Center, Gifu, Japan.
authors.forename: Atsunari
authors.initials: A
authors.lastname: Kino
authors.affiliation: Nutritional Support Team (NST), Nagara Medical Center, Gifu, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Terumasa
authors.initials: T
authors.lastname: Sowa
authors.affiliation: Department of General Thoracic Surgery, Nagara Medical Center, Gifu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of General Thoracic Surgery, Nagara Medical Center, Gifu, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Fujinaga
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D000077212:Ropivacaine; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000077212:Ropivacaine; D002045:Bupivacaine
keywords: Enhanced recovery after surgery (ERAS); Fast-track surgery; Paravertebral block; Video-assisted thoracic surgery (VATS)