title: A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief.
abstract: OBJECTIVE
  We conducted a comparative study to evaluate analgesic efficacy between paravertebral block via the surgical field (PVB-sf), in which the catheter was inserted into the ventral side of the sympathetic trunk in the paravertebral space by a thoracic surgeon under thoracoscopic visualization, and epidural block (Epi) using ropivacaine for post-thoracotomy pain relief.
  
  
  METHODS
  Lung cancer patients scheduled for lobectomy via thoracotomy were randomly allocated to receive either PVB-sf or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a 300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative pain was assessed using a visual analog scale (VAS) score at various time points, including the primary endpoint of 2 h after ropivacaine bolus injection. Sensory block area, vital signs, serum ropivacaine concentrations, and side effects were also evaluated.
  
  
  RESULTS
  The Epi group showed significantly lower VAS scores and blood pressure and a wider sensory block area than the PVB-sf group at all evaluation time points. While the mean serum ropivacaine concentration in the PVB-sf group was significantly higher than that in the Epi group until 1 h after injection of the ropivacaine bolus, there was no significant difference at any subsequent assessment point. The incidence of side effects was similar between the groups.
  
  
  CONCLUSIONS
  The Epi was superior to PVB-sf for the management of post-thoracotomy pain in this patient cohort. The number of dermatomes anaesthetized by Epi was greater than that anaesthetized by PVB-sf. No difference in complication rates was observed between the two groups.
authors.affiliation: Division of Anesthesia, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.|Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Division of Thoracic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Perioperative Management System, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mori
authors.affiliation: Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: Division of Anesthesia, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Yokota
authors.affiliation: Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shibata
authors.affiliation: Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan. nishi@med.nagoya-u.ac.jp.
authors.forename: Kimitoshi
authors.initials: K
authors.lastname: Nishiwaki
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000700:Analgesics / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D013908:Thoracotomy / Q000379:methods*
chemical_list: D000577:Amides; D000700:Analgesics; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Epidural block; Paravertebral block via the surgical field; Ropivacaine; Thoracotomy; Visual analog scale