title: Pain control of thoracoscopic major pulmonary resection: is pre-emptive local bupivacaine injection able to replace the intravenous patient controlled analgesia?
abstract: BACKGROUND
  The aim of this open-label, non-inferiority trial was to evaluate whether pre-emptive local bupivacaine injection (PLBI) can replace intravenous patient controlled analgesia (IV PCA) in video-assisted thoracic surgery (VATS) major pulmonary resection.
  
  
  METHODS
  A total of 86 patients scheduled for VATS segmentectomy/lobectomy were randomly assigned into two groups. The PLBI group (n=42) received 0.5% bupivacaine wound infiltration before skin incision, and the IV PCA group (n=44) received a continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. Visual analogue scale (VAS; range, 0-10) was measured as the primary endpoint. The secondary endpoint was an additional use of analgesics and drug induced side effects.
  
  
  RESULTS
  Both groups showed no difference in terms of age, sex, disease entity, operation time, chest tube indwelling time, and hospital stay. Serial pain scores between the PLBI and IV PCA groups demonstrated no statistical differences (non-inferiority margin; ΔVAS =1.0) (Recovery room: 8.3±2.1 vs. 8.5±1.7; Day 0: 5.1±1.6 vs. 5.2±1.4; Day 1: 3.5±1.6 vs. 3.3±1.2; Day 2: 2.7±1.3 vs. 2.5±1.2; Day 3: 2.3±1.3 vs. 2.1±1.5; 1 week after discharge: 3.0±1.7 vs. 2.8±1.5; 1 month: 1.9±1.2 vs. 2.3±1.4 and 2 months: 1.5±1.2 vs. 1.3±1.2; 95% confidential interval (CI) of ΔVAS <1.0; P>0.05). The mean one-additional usage of IV analgesics was needed in the PLBI group (3.3±2.1 vs. 2.3±1.3; P=0.03). The occurrence of nausea/vomiting was higher in the IV PCA group (12.5% vs. 38.9%; P=0.026) and 41.7% of IV PCA patients experienced drug side effects that required IV PCA removal within postoperative day (POD) 1.
  
  
  CONCLUSIONS
  PLBI is a simple, safe, effective, and economical method, which is not inferior to IV PCA in VATS major pulmonary resection.
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yang
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ja-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sukki
authors.initials: S
authors.lastname: Cho
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.affiliation: 1 Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; 2 Department of Thoracic and Cardiovascular Surgery, 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jun Sung
authors.initials: JS
authors.lastname: Kim
keywords: Video-assisted thoracic surgery (VATS); lobectomy; non-inferiority; postoperative pain; segmentectomy