Interventions
dislocation, NRS, pain
THORACIC, PLEURA, LOCAL ANESTHETICS
Patients’ baseline characteristics were evaluated during preoperative visits. The anesthesiologists educated the patients on the anesthetic process, use of analgesic pumps, 0 to10 points pain numerical rating scale (NRS) with 0-point indicating no pain and 10-point indicating the maximum degree of insufferable pain, and collected the patients’ preoperative pain NRS of the surgical sites.Thoracic paravertebral space catheterization was performed 30 min before anesthesia (Fig. Ultrasound-guided paravertebral block. P: Pleura, L: Lamina, *: Local anesthetics.Paravertebral block group patients used 25 ml of 0.5% ropivacaine as initial loading dose and continued with 0.2% ropivacaine as subsequent intermittent bolus dose. Control group patients used 25 ml 0.9% saline as initial loading dose and continued with 0.9% saline as subsequent intermittent bolus dose. To avoid inadvertent unmasking of the allocation, the extent of sensory block was not tested.After paravertebral block, general anesthesia with endotracheal intubation was performed with intravenous fentanyl (2 μg/kg), propofol (1.5–2.0 mg/kg) and rocuronium (0.6 mg/kg). Anesthesia was maintained with sevoflurane and a 50%OPatient-controlled intravenous morphine pump (Gemstar, Hospiria Inc., USA) was connected to the patient after extubation. Intravenous morphine was given with no background infusion, 1–2 mg per bolus, 5-min lockout interval and an upper limit of 8 mg per hour. If the patient still complained about pain with the upper limit dose, an intravenous Cox-2 inhibitor was given as rescue analgesia. Both paravertebral and intravenous analgesia was provided until 48 h postoperatively. All patients received same postoperative recovery program including daily crystalloid and nutrition infusion, oral clear fluid intake on postoperative day one and food intake after passing gas. No laxatives were given before oral food intake. If catheter dislocation happened, re-catheterization was decided by the patient. Two trained clinicians visited the patients and assessed the outcomes in the ward at postoperative 2, 4, 12, 24 and 48 h. Follow-up after discharge was completed via clinical visits or telephones at postoperative 3 months.