This prospective, randomized, double-blind study was approved by Pusan National University Hospital’s Institutional Review Board (No. H-1807-029-069) and was registered with cris.nih.go.kr (registration number: KCT0003836; date of registration: August 31, 2018). This study was carried out in accordance with the principles of the Helsinki Declaration. An informed consent was obtained from 60 patients with the American Society of Anesthesiologists physical status classification I-II aged 18 to 85 years and scheduled for lung resection using VATS from October 2018 to May 2019 in Pusan National University Hospital, Busan, Korea. Patients who met any of the following criteria were excluded: inability to understand or give informed consent; chronic use of opioids or steroids; the presence of heart, liver, or kidney function abnormalities; infection at the site of the analgesic procedure; abnormal coagulation profile; or a body mass index higher than 30 kg/m2 (link)
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Two groups of patients having VATS were randomly assigned: Group E (n=30) got continuous epidural analgesia, while Group ES (n=30) received continuous ESP block. They were allocated to each group using block randomization tables generated using Randomization.com (http://www.randomization.com). A single anesthesiologist performed all analgesic procedures before inducing general anesthesia in the operating theatre. Ultrasound was used to identify vertebral levels in both groups and guide needle advance and catheter placement in the ESP block group. Fluoroscopy was applied to check the catheter tip position in both groups and confirm the epidural space in the epidural group. Ultrasound and fluoroscopy were used with all patients, so patients could not tell which procedure was performed. Researchers who did not attend the analgesic procedures recorded the postoperative pain score and complications. In addition, patient-controlled analgesia (PCA) pump settings and drugs were also recorded using an electronic data collection tool.
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