{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:26:28Z","timestamp":1785270388997,"version":"3.55.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The optimal perioperative analgesic strategy in video-assisted thoracic surgery (VATS) for anatomic lung resections remains an open issue. Regional analgesic concepts as thoracic paravertebral or epidural analgesia were used as systemic opioid application. We hypothesized that regional anesthesia would provide improved analgesia compared to systemic analgesia with parenteral opioids in VATS lobectomy and would be associated with a lower incidence of pulmonary complications.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The study was approved by the local ethics committee (AZ 99\/15) and registered (germanctr.de; DRKS00007529, 10th June 2015). A retrospective analysis of anesthetic and surgical records between July 2014 und February 2016 in a single university hospital with 103 who underwent VATS lobectomy. Comparison of regional anesthesia (i.e. thoracic paravertebral blockade (group TPVB) or thoracic epidural anesthesia (group TEA)) with a systemic opioid application (i.e. patient controlled analgesia (group PCA)). The primary endpoint was the postoperative pain level measured by Visual Analog Scale (VAS) at rest and during coughing during 120\u2009h. Secondary endpoints were postoperative pulmonary complications (i.e. atelectasis, pneumonia), hemodynamic variables and postoperative nausea and vomiting (PONV).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Mean VAS values in rest or during coughing were measured below 3.5 in all groups showing effective analgesic therapy throughout the observation period. The VAS values at rest were comparable between all groups, VAS level during coughing in patients with PCA was higher but comparable except after 8\u201316\u2009h postoperatively (PCA vs. TEA; <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.004). There were no significant differences on secondary endpoints. Intraoperative Sufentanil consumption was significantly higher for patients without regional anesthesia (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.0001 vs. TPVB and vs. TEA). The morphine equivalence postoperatively applicated until POD 5 was comparable in all groups (mean\u2009\u00b1\u2009SD in mg: 32\u2009\u00b1\u200929 (TPVB), 30\u2009\u00b1\u200927 (TEA), 36\u2009\u00b1\u200930 (PCA); <jats:italic>p<\/jats:italic>\u00a0=\u20090.6046).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Analgesia with TEA, TPVB and PCA provided a comparable and effective pain relief after VATS anatomic resection without side effects. Our results indicate that PCA for VATS lobectomy may be a sufficient alternative compared to regional analgesia.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>The study was registered (germanctr.de; <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.drks.de\/drks_web\/navigate.do?navigationId=trial.HTML&amp;TRIAL_ID=DRKS00007529\">DRKS00007529<\/jats:ext-link>; 10th June, 2015).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12871-019-0851-2","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T13:10:08Z","timestamp":1571317808000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Regional versus systemic analgesia in video-assisted thoracoscopic lobectomy: a retrospective analysis"],"prefix":"10.1186","volume":"19","author":[{"given":"Benedikt","family":"Haager","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Eschbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernward","family":"Passlick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6147-8281","authenticated-orcid":false,"given":"Torsten","family":"Loop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,10,17]]},"reference":[{"key":"851_CR1","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1093\/ejcts\/ezt525","volume":"45","author":"KJ Steinthorsdottir","year":"2014","unstructured":"Steinthorsdottir KJ, Wildgaard L, Hansen HJ, et al. Regional analgesia for video-assisted thoracic surgery: a systematic review. Eur J Cardiothorac Surg. 2014;45:959\u201366.","journal-title":"Eur J Cardiothorac Surg"},{"key":"851_CR2","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1093\/ejcts\/ezv154","volume":"49","author":"PE Falcoz","year":"2016","unstructured":"Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg. 2016;49:602\u20139.","journal-title":"Eur J Cardiothorac Surg"},{"key":"851_CR3","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1016\/S1470-2045(16)00173-X","volume":"17","author":"M Bendixen","year":"2016","unstructured":"Bendixen M, Jorgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17:836\u201344.","journal-title":"Lancet Oncol"},{"key":"851_CR4","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.athoracsur.2005.07.078","volume":"81","author":"RJ McKenna Jr","year":"2006","unstructured":"McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81:421\u20135.","journal-title":"Ann Thorac Surg"},{"key":"851_CR5","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1213\/01.ane.0000333274.63501.ff","volume":"107","author":"GP Joshi","year":"2008","unstructured":"Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107:1026\u201340.","journal-title":"Anesth Analg"},{"key":"851_CR6","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/ACO.0b013e3283414175","volume":"24","author":"M Wenk","year":"2011","unstructured":"Wenk M, Schug SA. Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol. 2011;24:8\u201312.","journal-title":"Curr Opin Anaesthesiol"},{"key":"851_CR7","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.1053\/j.jvca.2018.01.003","volume":"32","author":"H Shanthanna","year":"2018","unstructured":"Shanthanna H, Moisuik P, O'Hare T, et al. Survey of postoperative regional analgesia for thoracoscopic surgeries in Canada. J Cardiothorac Vasc Anesth. 2018;32:1750\u20135.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"851_CR8","first-page":"336","volume":"47","author":"DM Popping","year":"2012","unstructured":"Popping DM, Wenk M, Van Aken HK. Neurologic complications after epidural analgesia. AINS. 2012;47:336\u201343.","journal-title":"AINS"},{"issue":"Suppl 1","key":"851_CR9","doi-asserted-by":"publisher","first-page":"i96","DOI":"10.1093\/bja\/aer381","volume":"107","author":"TT Horlocker","year":"2011","unstructured":"Horlocker TT. Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. Br J Anaesth. 2011;107(Suppl 1):i96\u2013106.","journal-title":"Br J Anaesth"},{"key":"851_CR10","first-page":"616","volume":"75","author":"M Messina","year":"2009","unstructured":"Messina M, Boroli F, Landoni G, et al. A comparison of epidural vs. paravertebral blockade in thoracic surgery. Minerva Anestesiol. 2009;75:616\u201321.","journal-title":"Minerva Anestesiol"},{"key":"851_CR11","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.1213\/ANE.0b013e3181da82c8","volume":"110","author":"P Thavaneswaran","year":"2010","unstructured":"Thavaneswaran P, Rudkin GE, Cooter RD, et al. Brief reports: paravertebral block for anesthesia: a systematic review. Anesth Analg. 2010;110:1740\u20134.","journal-title":"Anesth Analg"},{"key":"851_CR12","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1016\/j.athoracsur.2004.07.030","volume":"79","author":"E Marret","year":"2005","unstructured":"Marret E, Bazelly B, Taylor G, et al. Paravertebral block with ropivacaine 0.5% versus systemic analgesia for pain relief after thoracotomy. Ann Thorac Surg. 2005;79:2109\u201313.","journal-title":"Ann Thorac Surg"},{"key":"851_CR13","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1097\/00000542-200109000-00033","volume":"95","author":"MK Karmakar","year":"2001","unstructured":"Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95:771\u201380.","journal-title":"Anesthesiology"},{"key":"851_CR14","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1093\/bja\/ael020","volume":"96","author":"RG Davies","year":"2006","unstructured":"Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96:418\u201326.","journal-title":"Br J Anaesth"},{"key":"851_CR15","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1093\/bja\/aeq379","volume":"106","author":"ES Powell","year":"2011","unstructured":"Powell ES, Cook D, Pearce AC, et al. A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy. Br J Anaesth. 2011;106:364\u201370.","journal-title":"Br J Anaesth"},{"key":"851_CR16","doi-asserted-by":"crossref","unstructured":"Hudcova J, McNicol E, Quah C, et al. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2006;4:CD003348.","DOI":"10.1002\/14651858.CD003348.pub2"},{"key":"851_CR17","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1093\/bja\/aes394","volume":"110","author":"S Dango","year":"2013","unstructured":"Dango S, Harris S, Offner K, et al. Combined paravertebral and intrathecal vs thoracic epidural analgesia for post-thoracotomy pain relief. Br J Anaesth. 2013;110:443\u20139.","journal-title":"Br J Anaesth"},{"key":"851_CR18","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1093\/bja\/81.2.230","volume":"81","author":"J Richardson","year":"1998","unstructured":"Richardson J, Lonnqvist PA. Thoracic paravertebral block. Br J Anaesth. 1998;81:230\u20138.","journal-title":"Br J Anaesth"},{"key":"851_CR19","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1016\/S0140-6736(03)14966-5","volume":"362","author":"H Kehlet","year":"2003","unstructured":"Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921\u20138.","journal-title":"Lancet"},{"key":"851_CR20","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1097\/AJP.0b013e318174badd","volume":"24","author":"A Gottschalk","year":"2008","unstructured":"Gottschalk A, Ochroch EA. Clinical and demographic characteristics of patients with chronic pain after major thoracotomy. Clin J Pain. 2008;24:708\u201316.","journal-title":"Clin J Pain"},{"key":"851_CR21","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.jclinane.2016.07.029","volume":"35","author":"H Shanthanna","year":"2016","unstructured":"Shanthanna H, Aboutouk D, Poon E, et al. A retrospective study of open thoracotomies versus thoracoscopic surgeries for persistent postthoracotomy pain. J Clin Anesth. 2016;35:215\u201320.","journal-title":"J Clin Anesth"},{"key":"851_CR22","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1053\/j.jvca.2016.08.010","volume":"31","author":"J Hutchins","year":"2017","unstructured":"Hutchins J, Sanchez J, Andrade R, et al. Ultrasound-guided paravertebral catheter versus intercostal blocks for postoperative pain control in video-assisted thoracoscopic surgery: a prospective randomized trial. J Cardiothorac Vasc Anesth. 2017;31:458\u201363.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"851_CR23","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1053\/j.jvca.2014.11.006","volume":"29","author":"C Duale","year":"2015","unstructured":"Duale C, Gayraud G, Taheri H, et al. A French Nationwide survey on anesthesiologist-perceived barriers to the use of epidural and paravertebral block in thoracic surgery. J Cardiothorac Vasc Anesth. 2015;29:942\u20139.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"851_CR24","doi-asserted-by":"publisher","first-page":"930","DOI":"10.3346\/jkms.2009.24.5.930","volume":"24","author":"JA Kim","year":"2009","unstructured":"Kim JA, Kim TH, Yang M, et al. Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy? J Korean Med Sci. 2009;24:930\u20135.","journal-title":"J Korean Med Sci"},{"key":"851_CR25","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.aat.2012.08.004","volume":"50","author":"JC Yie","year":"2012","unstructured":"Yie JC, Yang JT, Wu CY, et al. Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: comparison of epidural PCA and intravenous PCA. Acta Anaesthesiol Taiwanica. 2012;50:92\u20135.","journal-title":"Acta Anaesthesiol Taiwanica"},{"key":"851_CR26","first-page":"313","volume":"12","author":"M Yoshioka","year":"2006","unstructured":"Yoshioka M, Mori T, Kobayashi H, et al. The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study. Ann Thorac Cardiovasc Surg. 2006;12:313\u20138.","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"851_CR27","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1093\/icvts\/ivt551","volume":"18","author":"DK Baidya","year":"2014","unstructured":"Baidya DK, Khanna P, Maitra S. Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014;18:626\u201335.","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"851_CR28","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1016\/j.athoracsur.2008.12.099","volume":"87","author":"TL Demmy","year":"2009","unstructured":"Demmy TL, Nwogu C, Solan P, et al. Chest tube-delivered bupivacaine improves pain and decreases opioid use after thoracoscopy. Ann Thoracic Surg. 2009;87:1040\u20136.","journal-title":"Ann Thoracic Surg"},{"key":"851_CR29","doi-asserted-by":"publisher","first-page":"280","DOI":"10.5603\/AIT.2016.0059","volume":"48","author":"S Kosinski","year":"2016","unstructured":"Kosinski S, Fryzlewicz E, Wilkojc M, et al. Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy: a randomised, non-inferiority trial. Anaesthesiol Intens Ther. 2016;48:280\u20137.","journal-title":"Anaesthesiol Intens Ther"},{"key":"851_CR30","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1097\/00000542-200003000-00028","volume":"92","author":"A Macario","year":"2000","unstructured":"Macario A, Scibetta WC, Navarro J, et al. Analgesia for labor pain: a cost model. Anesthesiology. 2000;92:841\u201350.","journal-title":"Anesthesiology"},{"key":"851_CR31","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1093\/bja\/aei270","volume":"96","author":"E Bartha","year":"2006","unstructured":"Bartha E, Carlsson P, Kalman S. Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery. Br J Anaesth. 2006;96:111\u20137.","journal-title":"Br J Anaesth"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-019-0851-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12871-019-0851-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-019-0851-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T23:11:23Z","timestamp":1602803483000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-019-0851-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,17]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["851"],"URL":"https:\/\/doi.org\/10.1186\/s12871-019-0851-2","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,17]]},"assertion":[{"value":"27 August 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the local Ethics Committee University of Freiburg, Germany (approval number AZ 99\/15; Ethik-Kommission der Albert-Ludwigs-Universit\u00e4t Freiburg, Engelberger Stra\u00dfe 21, 79106 Freiburg).An individual consent of the patients was not required because all methods of analgesia are standard approachs in our institution. The study has a retrospective design, and only closed cases were enclosed. The institutional review board declined the need for retrospective information and consent of the analyzed patients.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}