• Yeap Yar Luan YL Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN. Electronic address: yyeap@iu.edu., John W Wolfe, Kevin M Backfish-White, Jerry V Young, Jennifer Stewart, Duykhanh P Ceppa, Moser Elizabeth A S EAS Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN., and Thomas J Birdas.
• Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN. Electronic address: yyeap@iu.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Jul 1; 34 (7): 1870-1876.

ObjectiveVideo-assisted thoracoscopic surgery (VATS) has improved patient outcomes; however, postoperative pain remains potentially severe. The objective of this study was to compare adjunct analgesic modalities for VATS, including paravertebral nerve blockade (PVB) and thoracic epidural anesthesia (TEA).DesignProspective, randomized trial.SettingLarge academic hospital, single institution.ParticipantsAdult patients undergoing VATS.InterventionsUltrasound-guided PVB catheter, ultrasound-guided single-injection PVB, or TEA.Measurements And Main ResultsPostoperative visual analog scale pain scores (at rest and with knee flexion) and opioid usage were recorded. Pain scores (with movement) for the TEA group were lower than those for either PVB group at 24 hours (p ≤ 0.008) and for the PVB catheter group at 48 hours (p = 0.002). Opioid use in TEA group was lower than that for either PVB group at 24 and 48 hours (p < 0.001) and 72 hours (p < 0.05). Single-injection PVB was faster compared with PVB catheter placement (6 min v 12 min; p < 0.001) but similar to TEA (5 min). Patient satisfaction, nausea, sedation, and 6-month postsurgical pain did not differ between groups.ConclusionsTEA led to lower pain scores and opioid requirement for VATS procedures compared with PVB techniques. Single-injection PVB was faster and equally as effective as PVB catheter, and it led to similar patient satisfaction as TEA; therefore, it should be considered in patients who are not ideal candidates for TEA.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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