• Fatma Nur Kaya, Gurkan Turker, Elif Basagan-Mogol, Suna Goren, Sami Bayram, and Cengiz Gebitekin.
• Department of Anesthesiology and Reanimation, Uludag University Medical School, Bursa, Turkey. fnurk@uludag.edu.tr <fnurk@uludag.edu.tr>
• J. Cardiothorac. Vasc. Anesth. 2006 Oct 1;20(5):639-43.

ObjectiveThe hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures.DesignProspective, randomized, controlled, blinded study.SettingSingle-university hospital.ParticipantsFifty consenting patients undergoing video-assisted thoracic surgery.InterventionsPatients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25).Measurements And Main ResultsIntraoperative fentanyl consumption was lower in the PVB group (p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (p < 0.05 and p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (p < 0.01 for 0 hours and p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (p < 0.05 for 12 hours and p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (p < 0.05), and first mobilization and hospital discharge were quicker (p < 0.01 and p < 0.05, respectively) in the PVB group.ConclusionPerioperative multiple-injection thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.

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