General anesthesia and surgery
dermatomal sensory, postoperative nausea and vomiting, skin block, Nausea, Hypotension, NRS
ADVERSE EVENTS
General anesthesia was induced using a target-controlled infusion (TCI) pump with effect site concentration of 3-4 µg/mL for propofol and 3 ng/mL for remifentanil, with 0.6 mg/kg rocuronium. Maintenance of anesthesia was accomplished by titrating propofol by TCI according to a bispectral index response of 40 to 60. Depending on the strength of the surgical stimulus, the effect-site TCI of remifentanil was titrated. All patients took 0.3 mg ramosetron to prevent postoperative nausea and vomiting before extubation.Surgeons performed VATS using 3 ports located at 4, 6, and 7 intercostal space; a 40-100 mm length working window and 2 small ports for thoracoscopy and instrument. A chest tube was inserted via one of the port incisions at the conclusion of the operation.Following surgery, patients were transported to the post-anesthesia care unit or critical care unit. Both groups were given 1 g intravenous propacetamol hydrochloride (Denogan) 3 times per day. Patients were treated with 3 mg morphine sulfate as a rescue analgesic medication when they still had NRS score of 4 or more 20 minutes after a patient-administered bolus of PCA system.The primary outcome measure in this study was comparing the numerical rating scale (NRS) scores at rest 24 hours postoperatively between the 2 groups. The NRS score was measured with a 0-10, visually enlarged, laminated numerical rating scale for minimizing the effect of the patient’s awareness at 1, 3, 6, 12, 24, and 48 hours postoperatively. Secondary outcomes were divided into 4 categories: i) block characteristics, ii) rescue medication, iii) adverse events, and iv) patient satisfaction.In block characteristics, the procedure time (from skin block to catheter indwelling) and the location of the catheter tip were recorded. The dermatomal sensory range after loading dose administration was measured using the pinprick test 1 hour after surgery. Data on rescue analgesic medication were taken from the electronic medical record (EMR) and nurses during the follow-up period. Information on adverse events was collected from patients, nurses, and EMR. Nausea was defined when rescue antiemetics were administered. Hypotension was diagnosed when systolic blood pressure was less than 90 or vasopressor was needed. Patient satisfaction was checked with a 5-point scale (5=very satisfied, 4=satisfied, 3=neutral, 2=unsatisfied, 1=very unsatisfied) just after the procedure and at last follow-up. Postoperative follow-up visits were done 1, 3, 6, 12, 24, and 48 hours after surgery.