title: Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To compare paravertebral block under thoracoscopy with wound infiltration at an early stage after video-assisted thoracic lobectomy surgery.
  
  
  METHODS
  A prospective, randomized, triple-blinded, placebo-controlled trial.
  
  
  METHODS
  A single-center university hospital.
  
  
  METHODS
  Patients scheduled for video-assisted thoracic lobectomy surgery between February 20, 2014 and June 1, 2014 randomly were allocated into paravertebral block (PVB) (n = 35) and infiltration (n = 35) groups.
  
  
  METHODS
  In the PVB group, 0.5% ropivacaine was injected into the paravertebral space by the surgeon under direct vision with placebo infiltration of saline in the wounds. In the infiltration group, the wounds were infiltrated with 0.5% ropivacaine by the surgeon with a placebo paravertebral block. Subsequently, patient-controlled intravenous morphine analgesia and paracoxib were administered.
  
  
  RESULTS
  The primary endpoints were visual analog scale (VAS) pain scores at rest and on cough 0, 2, 6, and 24 hours after surgery. The secondary endpoints were the total morphine during postoperative 0 hours to 24 hours, adverse events, and patient satisfaction with the analgesia. Sixty-one patients completed the study. VAS score on cough at each time point was significantly lower (p<0.05) and median (25th, 75th) morphine consumption was lower in the PVB group than in the infiltration group (26 [10, 35] mg and 42 [29, 58] mg, p<0.001, respectively). There was no difference in VAS score at rest. Patients in the PVB group had higher satisfaction with analgesia than in the infiltration group (p = 0.003).
  
  
  CONCLUSIONS
  As part of the multimodal postoperative analgesia, intraoperative paravertebral block provided better dynamic pain relief and reduced morphine consumption compared with local wound infiltration.
authors.affiliation: Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Xuezheng
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Luowa
authors.initials: L
authors.lastname: Shu
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Chaoxi
authors.initials: C
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Pulmonary Medicine, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Quanguang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Yiquan
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Xuzhong
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Cui
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China. Electronic address: jinlielieans@126.com.
authors.forename: Lielie
authors.initials: L
authors.lastname: Jin
authors.affiliation: Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Tianzuo
authors.initials: T
authors.lastname: Li
mesh_terms: D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid
keywords: nerve block/methods; pain; paravertebral block; postoperative; thoracic surgery; video-assisted