To access the analgesic efficacy of patient controlled thoracic paravertebral analgesia.
The study was carried out on thirty patients who underwent video-assisted thoracic surgery.Paravertebral space was identified by loss of resistance technique under video-assisted inside thoracic space before chest close.Initiated dose of 0.3ml/kg of bupivacaine 0.125%+fentanyl 2 mcg/ml was administered then continued patient-controlled analgesia with background rate 3ml/h, bolus dose 2ml, lockout interval 10 minutes. Postoperative pain was accessed by Visual Analogue Scale at rest and on coughing; monitor the heart rate, blood pressure, respiratory rate, SpO2, arterial blood gas and spirometry in three postoperative consecutive days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
General anesthesia was induced with 2.0 mg/kg of propofol, 2.0 mg/kg of fentanyl, and 1.0 mg kg/1 of rocuronium and maintained with continuous infusion 6-12mg/kg/h of propofol,injected 2.0 mg/kg of fentanyl and 0.15 mg/ kg of rocuronium every 30 minutes . All patients were intubated with a double-lumen endobronchial tube for one-lung ventilation.The VATS (Video-Assisted Thoracic Surgery) was performed.
At the end of the surgery, the upper edge of the spinous process of the thoracic vertebral body was recognized. With an epidural needle (Tuohy 22 G; Braun, Melsungen, Germany), the injection point was punctured 2 cm lateral to the midline. The paravertebral space was entered by advancing the Tuohy needle over the superior border of the transverse process. Once in the right place, the PVC was placed through the needle, checking the tip remained placed when removing the needle. The advance of the needle and the entering of the catheter into the paravertebral space were verified all the time by the surgeon using the camera. The PVC (Paravertebral Catheter ) was inserted at this point preversed at this area.
Vietnam Military Medical University
Hanoi, Vietnam
VAS score at rest and on coughing
Using VAS scale (Atrazennica)
Time frame: 72 hours
Analgesia effects on respiratory function
Using Spirometry (Chestgraph H1 - 105,Japane) to evaluate respiratory index
Time frame: three postoperative consecutive days
Arterial blood gas values
Using Arterial blood gas analysis (STAT Model No.MCP9819-065, Martel Instruments Ltd)
Time frame: three postoperative consecutive days
The number dermatome inhibition
Using pin-prick test
Time frame: three postoperative consecutive days
Rescue analgesia
When VAS score equal to or more than 4 using fentanyl to manage pain
Time frame: three postoperative consecutive days
Patient's satisfaction
Using questionaire with 4 levels :not good,satisfied,good,very good
Time frame: three postoperative consecutive days
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PVC was inserted.Initiated dose of 0.3ml/kg of Bupivacaine Hydrochloride 1.25mg/ml and Fentanyl Citrate 2 micrograms/ml was administered then continued PCA (Perfusor space pump,Germany)with background rate 3ml/h, bolus dose 2ml was infused through PVC.