Thoracic paravertebral nerve block (TPVB) has been reported to be as effective as thoracic epidural analgesia in perioperative pain management for the thoracic surgery. However, there were a few reports, which investigated the analgesic efficacy and the safety for the TPVB for the thoracic surgery. In this time, we investigated the analgesic efficacy of the TPVB in video-assisted thoracoscopic surgery compared with the thoracic epidural analgesia.
Method: Eighty adult patients for video-assisted thoracoscopic surgery were randomly allocated to receive either the combination of general anaesthesia and TPVB (T group, n=40) or the combination of general anaesthesia and epidural anaesthesia (E group, n=40).  Before the induction of general anaesthesia, the patients were inserted with a catheter into paravertebral or epidural space between the 5th and 6th rib, or the 6th and 7th rib at the back. After the induction of general anaesthesia using fentanyl, propofol. and rocuronium, the endotracheal tube was then inserted into the trachea. Anaesthesia was maintained with total intravenous anaesthesia (propofol and remifentanil). Rocuronium was administered at the discretion of the anaesthetists. Additional 50 - 100μg fentanyl boluses were administered to maintain blood pressure or heart rate values within 30 % of the first documented vital signs obtained when the patient entered the operation room. 
 At the closed-chest, 20 mL of 0.375% levobupivacaine was injected from the catheter inserted into the paravertebral or epidural space. Then the catheter was attached to a CADD○R-Solis PIBs (CADD, Smiths Medical Japan Ltd., Tokyo, CADD), which are patient-controlled analgesia devices. The set flow rate of CADD was with a continuous infusion of 6 mL lebobupivacaine (0.125%) every hour.
Primary outcome measure was the number of additional fentanyl injections during the first 24 hours after surgery. Secondary outcomes were the number of required additional fentanyl doses and were visual analog scale (VAS) pain score during the first 24 hours after surgery. The measured data was analyzed using the Wilcoxon-Mann-Whitney U-test to assess the differences between the 2 groups.
Results: The number of additional fentanyl to the T group was equal to the E group (P=0.075). The number of required additional fentanyl doses was lower in the E group than in the T group (P=0.075). Compared with the T group, the E group was lower VAS scores of the rest at 2, 4, 6, 18 and 24 hours post-surgery and of the move at 2, 4, 6, 12, 18 and 24 hours post-surgery.
Conclusion: The number of additional fentanyl to the T group was equal to the E group. The thoracic paravertebral nerve block is as effective as the epidural analgesia in video-assisted thoracoscopic surgery.


02 / Efficacy of thoracic paravertebral nerve block for patients who undergo video-assisted thoracoscopic surgery- randomised controlled trial-