• Christian Bauer, Isabelle Pavlakovic, Catherine Mercier, Jean-Michel Maury, Catherine Koffel, Pascal Roy, and Jean-Luc Fellahi.
• From the Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Anesthésie-Réanimation (CB), Hospices Civils de Lyon, Hôpital Cardiologique et Pneumologique Louis Pradel, Service d'Anesthésie-Réanimation (IP, CK, J-LF), Hospices Civils de Lyon, Service de Biostatistique - Bioinformatique (CM, PR), Faculté de Médecine, Université Claude Bernard Lyon 1 (CM, PR, J-LF), CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Département Biostatistiques et modélisation pour la santé et l'environnement, Equipe Biostatistique-Santé (CM, PR) and Hospices Civils de Lyon, Hôpital Cardiologique et Pneumologique Louis Pradel, Service de Chirurgie Thoracique, Lyon, France (J-MM).
• Eur J Anaesthesiol. 2018 Oct 1; 35 (10): 766-773.

BackgroundThe benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear.ObjectivesTo analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS.DesignA randomised, double-blinded, single-centre clinical trial.SettingA tertiary university hospital between March 2010 and April 2014.PatientsNinety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study.InterventionTo receive thoracic paravertebral analgesia with either 2 mg ml ropivacaine and 0.25 μg ml sufentanil (ropivacaine + sufentanil group) or 2 mg ml ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg h in both groups.Main Outcome MeasuresThe primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively.ResultsThe mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay.ConclusionAdding 0.25 μg ml sufentanil to 2 mg ml ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed.Trial RegistrationClinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744.

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