Patient-Controlled Paravertebral Block for Video-Assisted Thoracic Surgery: A Randomized Trial

Background. Paravertebral block (PVB) has been proven to be an efficient way to control postoperative pain in patients who have undergone a thoracotomy. This study explored whether the use of a patient-controlled PVB can provide benefits over intravenous patientcontrolled analgesia (PCA) for 3-port single-intercostal video-assisted thoracic surgery. Methods. From May 2015 to December 2016, patients who had solitary pulmonary nodules or spontaneous pneumothorax and underwent single-intercostal videoassisted thoracic surgery were randomly allocated to receive patient-controlled PVB or intravenous PCA. Intramuscular dezocine (10 mg) was used as a rescue medication. None of the surgeons, patients, or investigators assessing outcomes or analyzing the data were blinded to the group assignments. Pain level was measured by the visual analog score. Results. There were 86 patients assigned to the PVB group and 85 patients assigned to the PCA group. The difference in the mean visual analog score between these two groups was not significant (p = 0.115). For patients who needed rescue medication, the cumulative dezocine dose in the PVB group was significantly lower than that in the PCA group (21.7 mg vs 30.9 mg, p = 0.001) throughout the 4 postoperative days. The frequencies of severe vomiting (p = 0.003) and hypotension (p = 0.005) were significantly lower in the PVB group. Conclusions. PVB, which resulted in lower cumulative dezocine doses and produced fewer side effects than PCA, can provide effective pain relief for patients undergoing video-assisted thoracic surgery. (C) 2018 by The Society of Thoracic Surgeons