Perioperative pain management
pain
The thoracic epidural catheter is placed preoperatively (before induction of anaesthesia) at the vertebral level of Th 6–9. After a test dose with 3.5 ml 1% prilocaine to exclude intraspinal placement, epidural regional anaesthesia will be started with a bolus injection of 10 ml ropivacaine hydrochloride 0.3% and 20 µg sufentanil after induction of anaesthesia and at least 20 min before skin incision. Immediately afterwards, a continuous infusion of 5 ml/h ropivacaine hydrochloride 0.2% will be maintained for at least 2 days. Additional epidural boluses of 5 ml are allowed every 20 min at the discretion of the anaesthesiologist during the operation and according to the need of the patient postoperatively. After the initial 200-ml bag of ropivacaine hydrochloride, 0.2% plus 0.5 µg/ml sufentanil is empty, the replacement will be done without sufentanil, with pure ropivacaine hydrochloride 0.2%. Postoperatively, the concomitant pain medication will consist of 1 g of metamizole or 1 g of paracetamol 4 times daily. That can be extended to 10 mg extended-release oxycodone (every 12 h) and an on-demand medication of 10 mg immediate-release oxygesic if necessary, in case of a persistent pain score > 4 according to the numeric rating scale (NRS).The running rate and dosage will be checked daily by the pain service and adjusted to the individual needs of the patient (including increasing the basal rate to a maximum of 8 ml/h, reducing/terminating the basal rate of continuous epidural infusion and removal of the catheter).