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Appendices

Relationship between quality and source of evidence, levels of evidence and GoRs of recommendation

Study quality assessments Level of Evidence (LoE) GoR of recommendation

(based on overall LoE, considering balance of clinical practice information and evidence)
Study type Statistical analyses and patient follow-up assessment   Allocation concealment Jadad scores Additional assessment of overall study quality required to judge LoE   Procedure-specific
Systematic review with homogeneous results N/A N/A N/A N/A 1 A
Randomised controlled trial (RCT) Statistics reported

and >80%

follow-up

 AND A (1–5) N/A 1 A

(based on two or more studies or a single large, well-designed study)
OR
B (3–5) N/A
OR
B (1–2) Yes
RCT Statistics not reported or questionable or <80% follow-up AND/OR B (1–2) Yes 2 B

(or extrapolation from one procedure-specific

LoE 1 study)
OR
C (1–5) N/A
OR
D (1–5) N/A
Non-systematic review, cohort study,

case study; (e.g. some adverse effects evidence)

 N/A N/A 3 C
Clinical practice information (expert opinion); inconsistent evidence N/A N/A 4 D

*Allocation concealment: A, adequate; B, unclear; C, inadequate; D, not use

 

 

 

Thoracotomy: Search strategy (Medline, Embase, CENTRAL)

Last update search conducted: 2008–2015
Search in Medline and Embase using Embase as search engine

Search term
1 (pain OR analgesi* OR anaesthesi* OR anesthesi* OR  “visual analogue” OR VRS OR McGill OR epidural OR neuraxial OR intrathecal OR caudal OR spinal OR “paravertebral block” OR narcotic OR cryo OR intrapleural OR “intercostal block” OR “continuous intercostal nerve block” OR “combined epidural-general” OR “combined regional-general”) AND (Lobectomy OR “Thoracic surgery” OR “Intrathoracic surgery” OR “Hemithoracic surgery” OR “Chest surgery” OR Thoracotomy OR Postthoracotomy OR Post-thoracotomy OR “Post thoracotomy” OR Cardio-thoracic OR Cardiothoracic OR Pulmonectomy OR Pneumonectomy)

 

 

Thoracotomy: Included studies

1 Ali M, Winter DC, Hanly AM, et al. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.  Br J Anaesth. 2010;104(3):292–7. Pubmed link
2 Ammar AS, Mahmoud KM. Does the addition of magnesium to bupivacaine improve postoperative analgesia of ultrasound-guided thoracic paravertebral block in patients undergoing thoracic surgery? J Anesth. 2014;28(1):58–63. Pubmed link
3 Argiriadou H, Papagiannopoulou P, Foroulis CN, et al. Intraoperative infusion of S(+)-ketamine enhances post-thoracotomy pain control compared with perioperative parecoxib when used in conjunction with thoracic paravertebral ropivacaine infusion. J Cardiothorac Vasc Anesth. 2011;25(3):455–61. Pubmed link
4 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(5):626–35. Pubmed link
5 Behera BK, Puri GD, Ghai B. Patient-controlled epidural analgesia with fentanyl and bupivacaine provides better analgesia than IV morphine patient-controlled analgesia for early thoracotomy pain.  J Postgrad Med. 2008;54(2):86–90. Pubmed link
6 Cok OY, Eker HE, Turkoz A, et al. Thoracic epidural anaesthesia and analgesia during the perioperative period of thoracic surgery: levobupivacaine versus bupivacaine. J Cardiothorac Vasc Anesth. 2011;25(3):449–54. Pubmed link
7 Comez M, Celik M, Dostbil A, et al. The effect of pre-emptive IV dexketoprofen + thoracal epidural analgesia on the chronic post-thoracotomy pain. Int J Clin Exp Med. 2015;8(5):8101–7. Pubmed link
8 Cui W, Li Y, Li S, et al. Systemic administration of lidocaine reduces morphine requirements and postoperative pain of patients undergoing thoracic surgery after propofol-remifentanil-based anaesthesia. Eur J Anaesthesiol. 2010;27(1):41–6. Pubmed link
9 D’Alonzo RC, Bennett-Guerrero E, Podgoreanu M, et al. A randomized, double blind, placebo controlled clinical trial of the preoperative use of ketamine for reducing inflammation and pain after thoracic surgery. J Anesth. 201125:672–8. Pubmed link
10 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(3):443–9. Pubmed link
11 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(4):418–26. Pubmed link
12 Ding X, Jin S, Niu X, et al. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated meta-analysis. PLoS One. 2014;9(5):e96233. Pubmed link
13 Elhakim M, Abdelhamid D, Abdelfattach H, et al. Effect of epidural dexmedetomidine on intraoperative awareness and post-operative pain after one-lung ventilation. Acta Anaesthesiol Scand. 2010;54(6):703–9. Pubmed link
14 Esme H1, Apiliogullari B, Duran FM, et al. Comparison between intermittent IV analgesia and intermittent paravertebral subpleural analgesia for pain relief after thoracotomy. Eur J Cardiothorac Surg. 2012;41(1):10–3. Pubmed link
15 Feltracco P, Barbieri S, Rizzi S, et al. Perioperative analgesic efficacy and plasma concentrations of s(+)-ketamine in continuous epidural infusion during thoracic surgery. Anesth Analg. 2013;116(6):1371–5. Pubmed link
16 Fibla JJ, Molins L, Mier JM, et al. Comparative analysis of analgesic quality in the postoperative of thoracotomy: paravertebral block with bupivacaine 0.5% vs ropivacaine 0.2%. Eur J Cardiothorac Surg. 2008;33(3):430–4. Pubmed link
17 Fibla JJ, Molins L, Mier JM, et al. The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial. Eur J Cardiothorac Surg. 2011;40(4):907–11. Pubmed link
18 Fibla JJ, Molins L, Mier JM, et al. A randomized prospective study of analgesic quality after thoracotomy: paravertebral block with bolus versus continuous infusion with an elastomeric pump. Eur J Cardiothorac Surg. 2015;47(4):631–5. Pubmed link
19 Fiorelli A, Mazzella A, Passavanti B, et al. Is pre-emptive administration of ketamine a significant adjunction to IV morphine analgesia for controlling postoperative pain? A randomized, double-blind, placebo-controlled clinical trial. Interact Cardiovasc Thorac Surg. 2015;21(3):284–90. Pubmed link
20 Fiorelli A, Izzo AC, Frongillo EM, et al. Efficacy of wound analgesia for controlling post-thoracotomy pain: a randomized double-blind study. Eur J Cardiothorac Surg. 2016;49(1):339–47. Pubmed link
21 Grider JS, Mullet TW, Saha SP, et al. A randomized, double-blind trial comparing continuous thoracic epidural bupivacaine with and without opioid in contrast to a continuous paravertebral infusion of bupivacaine for post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2012;26(1):83–9. Pubmed link
22 Grosen K, Drewes AM, Højsgaard A, et al. Perioperative gabapentin for the prevention of persistent pain after thoracotomy: A randomized controlled trial. Eur J Cardiothorac Surg. 2014;46(1):76–85.  Pubmed link
23 Gulbahar G, Kocer B, Muratli SN, et al. A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg. 2010;37(2):467–72. Pubmed link
24 Gupta SD, Mitra K, Mukherjee M, et al.  Effect of magnesium infusion on thoracic epidural analgesia. Saudi J Anaesth. 2011;5(1):55–61. Pubmed link
25 Helms O, Mariano J, Hentz JG, et al. Intra-operative paravertebral block for postoperative analgesia in thoracotomy patients: a randomized, double-blind, placebo-controlled study. Eur J Cardiothorac Surg. 2011;40(4):902–6. Pubmed link
26 Hotta K, Endo T, Taira K, et al. Comparison of the analgesic effects of continuous extrapleural block and continuous epidural block after video-assisted thoracoscopic surgery. J Cardiothorac Vasc Anesth. 2011;25(6):1009–13. Pubmed link
27 Huot MP, Chouinard P, Girard F, et al. Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo –controlled study Can J Anaesth 2008;55:337–43. Pubmed link
28 Joseph C, Gaillat F, Duponq R, et al. Is there any benefit to adding IV ketamine to patient-controlled epidural analgesia after thoracic surgery? A randomized double-blind study. Eur J Cardiothorac Surg. 2012;42(4):e58–65. Pubmed link
29 Júnior Ade P, Erdmann TR, Santos TV, et al. Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy: Systematic review. Rev Bras Anestesiol. 2013;63(5):433–442. Pubmed link
30 Kanazi GE, Ayoub CM, Aouad M, et al. G. Subpleural block is less effective than thoracic epidural analgesia for post-thoracotomy pain: A randomised controlled study. Eur J Anaesthesiol. 2012;29(4):186–91. Pubmed link
31 Kaya FN, Turker G, Basagan-Mogol E, et al. Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery. J Cardiothorac Vasc Anesth 2006;20:639–43. Pubmed link
32 Kaya FN, Turker G, Mogol EB, et al. Thoracic paravertebral block for video-assisted thoracoscopic surgery: single injection versus multiple injections. J Cardiothorac Vasc Anesth. 2012;26(1):90–4. Pubmed link
33 Khanbhai M, Yap KH, Mohamed S, et al. Is cryoanalgesia effective for post-thoracotomy pain?  Interact Cardiovasc Thorac Surg. 2014;18(2):202–9. Pubmed link
34 Kinney MA1, Mantilla CB, Carns PE, et al. Preoperative gabapentin for acute post-thoracotomy analgesia: a randomized, double-blinded, active placebo-controlled study. Pain Pract. 2012;12(3):175–83. Pubmed link
35 Kotzé A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth. 2009;103(5):626–36. Pubmed link
36 Lee JH, Yang WD, Han SY, et al. Effect of epidural magnesium on the incidence of chronic postoperative pain after video-assisted thoracic surgery. J Cardiothorac Vasc Anesth. 2012;26(6):1055–9. Pubmed link
37 Li H, Wang B, Wang F, et al. Effects of epidural analgesia with different concentrations of bupivacaine plus fentanyl on pain in patients undergoing thoracic surgery. Int J Clin Exp Med. 2015;8(8):14123–6. Pubmed link
38 Meierhenrich R, Hock D, Kühn S, et al. Analgesia and pulmonary function after lung surgery: is a single intercostal nerve block plus patient-controlled IV morphine as effective as patient-controlled epidural anaesthesia? A randomized non-inferiority clinical trial. Br J Anaesth. 2011;106(4):580–9. Pubmed link
39 Messina M, Boroli F, Landoni G, et al. A comparison of epidural vs. paravertebral blockade in thoracic surgery. Minerva Anestesiol. 2009;75(11):616–21. Pubmed link
40 Mohammad W, Mir SA, Mohammad K, et al. A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulphate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief. Anesth Essays Res. 2015;9(1):15–20. Pubmed link
41 Momenzadeh S, Elyasi H, Valaie N, et al. The role of intercostal cryoanalgesia in post-thoracotomy analgesia. Acta Med Iran. 2011;49(4):241–5. Pubmed link
42 Nesher N, Ekstein MP, Paz Y, et al. Morphine with adjuvant ketamine vs higher dose of morphine alone for immediate postthoracotomy analgesia. Chest. 2009;136(1):245–252. Pubmed link
43 Ouerghi S, Fnaeich F, Frikha N, et al. The effect of adding intrathecal magnesium sulphate to morphine-fentanyl spinal analgesia after thoracic surgery. A prospective, double-blind, placebo-controlled research study. Ann Fr Anesth Reanim. 2011;30(1):25–30. Pubmed link
44 Sagiroglu G, Meydan B, Copuroglu E, et al. A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery. World J Surg Oncol. 2014;12:96. Pubmed link
45 Salengros JC, Huybrechts I, Ducart A, et al. Different anaesthetic techniques associated with different incidences of chronic post-thoracotomy pain: low-dose remifentanil plus presurgical epidural analgesia is preferable to high-dose remifentanil with postsurgical epidural analgesia. J Cardiothorac Vasc Anesth. 2010;24(4):608–16. Pubmed link
46 Samantaray A, Rao MH, Chandra A. et al. The effect on post-operative pain of IV clonidine given before induction of anaesthesia. Indian J Anaesth. 2012;56(4):359–64. Pubmed link
47 Scarci M, Joshi A, Attia R, et al. In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management? Interact Cardiovasc Thorac Surg. 2010;10(1):92–6. Pubmed link
48 Senard M, Deflandre EP, Ledoux D, et al. Effect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy. Br J Anaesth. 2010;105(2):196–200. Pubmed link
49 Sepsas E, Misthos P, Anagnostopulu M, et al. The role of intercostal cryoanalgesia in post-thoracotomy analgesia. Interact Cardiovasc Thorac Surg. 2013;16(6):814–8. Pubmed link
50 Tekelioglu UY, Gurses EL, Serin S, et al. Combinations of fentanyl and levobupivacaine for post-thoracotomy pain. Acta Anaesthesiol Taiwan. 2012;50(3):131–3. Pubmed link
51 Tena B, Gomar C, Rios J, et al. Perioperative epidural or IV ketamine does not improve the effectiveness of thoracic epidural analgesia for acute and chronic pain after thoracotomy. Clin J Pain. 2014;30(6):490–500. Pubmed link
52 Yang C, Chang H, Zhang T, et al. Pre-emptive epidural analgesia improves post-operative pain and immune function in patients undergoing thoracotomy. ANZ J Surg. 2015;85(6):472–7. Pubmed link
53 Yazigi A, Abou-Zeid H, Srouji T, et al. The effect of low‑dose IV ketamine on continuous intercostal analgesia following thoracotomy. Ann Card Anaesth. 2012;15(1):32–8. Pubmed link
54 Zeid HA, Siddiqui AK, Elmakarem EF, et al. Comparison between intrathecal morphine with paravertebral patient controlled analgesia using bupivacaine for intraoperative and post-thoracotomy pain relief. Saudi J Anaesth. 2012;6(3):201–6. Pubmed link
55 Zhang X, Shu L, Lin C, et al. Comparison between intraoperative two-space injection thoracic paravertebral block and wound infiltration as a component of multimodal analgesia for postoperative pain management after video-assisted thoracoscopic lobectomy: A randomized controlled trial. J Cardiothorac Vasc Anesth. 2015;29(6):1550–6. Pubmed link

 

 

 

Thoracotomy: Excluded studies

Inclusion criteria 1 not fulfilled: chronic pain trial or not a pain study

1 Ayad AE, El Masry A. Epidural steroid and clonidine for chronic intractable post-thoracotomy pain: A pilot study. Pain Practice 2012;12(1):1533-2500.
2 Brulotte V, Ruel MM, Lafontaine E et al. Impact of pregabalin on the occurrence of postthoracotomy pain syndrome: a randomized trial. Regional Anesthesia and Pain Medicine 2015;40(3)262–69.
3 Kampe S, Joachim Lohmer J, Gerhard Weinreich G, et al.  Epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy. Journal of Cardiothoracic Surgery 2013;8(1):127. doi:10.1186/1749-8090-8-127.
4 Novak-Jankoviĉ V, Paver-Erzen V, Bovill JG, et al. Effect of epidural and intravenous clonidine on the neuro-endocrine and immune stress response in patients undergoing lung surgery. European Journal of Anaesthesiology 17, no. 1 (January 2000): 50–56.
5 Sapkota R, Shrestha UK, Sayami P et al. Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain. Asian Cardiovascular & Thoracic Annals 2013;22(6):706–11. doi:10.1177/0218492313515498.
6 Song J-G, Shin JW, Lee EH et al. Incidence of post-thoracotomy pain: A comparison between total intravenous anaesthesia and inhalation anaesthesia. European Journal of Cardio-Thoracic Surgery 2012;41(5):1078–82. doi:10.1093/ejcts/ezr133.

Inclusion criteria 2 not fulfilled: surgical technique

1 Allama A M, Intercostal muscle flap for decreasing pain after thoracotomy: A prospective randomized trial. The Annals of Thoracic Surgery 2010;89(1):195–99. doi:10.1016/j.athoracsur.2009.07.094.
2 Ben-Nun A, Golan N, Faibishenko I, et al. Nonsteroidal antiinflammatory medications: efficient and safe treatment following video-assisted pleurodesis for spontaneous pneumothorax. World Journal of Surgery 2011;35(11):2563–67. doi:10.1007/s00268-011-1207-3.
3 Fibla JJ, Molins L, Mier JM et al. A prospective study of analgesic quality after a thoracotomy: paravertebral block with ropivacaine before and after rib spreading. European Journal of Cardio-Thoracic Surgery 2009;36(5):901–5. doi:10.1016/j.ejcts.2009.05.041.
4 Hall Burton, Denise M., and Karen R. Boretsky. A Comparison of Paravertebral Nerve Block Catheters and Thoracic Epidural Catheters for Postoperative Analgesia Following the Nuss Procedure for Pectus Excavatum Repair. Paediatric Anaesthesia 24, no. 5 (May 2014): 516–20. doi:10.1111/pan.12369.
5 Huot M-P, Chouinard P, Girard F et al. Gabapentin does not reduce post-thoracotomy shoulder pain: A randomized, double-blind placebo-controlled study. Canadian Journal of Anaesthesia 2008;55(6):337–43. doi:10.1007/BF03021488.
6 Kajiyama S, Miyoshi H, Kato T et al. Evaluation of postoperative pain intensity related to post-thoracotomy pain syndrome occurring after video-assisted thoracic surgery lobectomy for lung cancer. The Japanese Journal of Anesthesiology 2014;63(4):391–95.
7 Martinez-Barenys C, Busquets J, Lopez de Castro PE et al. Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery. European Journal of Cardio-Thoracic Surgery 2011;40(1):106–12. doi:10.1016/j.ejcts.2010.10.025.
8 Nosotti M, Baisi A, Mendogni P et al. Muscle sparing versus posterolateral thoracotomy for pulmonary lobectomy: randomised controlled trial. Interactive Cardiovascular and Thoracic Surgery 2010;11(4): 415–19. doi:10.1510/icvts.2010.238840.
9 Wu N, Yan S, Wang X et al. A prospective, single-blind randomised study on the effect of intercostal nerve protection on early post-thoracotomy pain relief. European Journal of Cardio-Thoracic Surgery 2010;37(4):840–45. doi:10.1016/j.ejcts.2009.11.004.

 

Inclusion criteria 3 not fulfilled: randomisation

1 Allen, Mark S., Lisa Halgren, Francis C. Nichols III, Stephen D. Cassivi, William S. Harmsen, Dennis A. Wigle, K. Robert Shen, and Claude Deschamps. A Randomized Controlled Trial of Bupivacaine Through Intracostal Catheters for Pain Management After Thoracotomy. The Annals of Thoracic Surgery 88, no. 3 (September 2009): 903–10. doi:10.1016/j.athoracsur.2009.04.139.  .
2 Askar, F. Z., S. Kocabas, S. Yucel, O. Samancilar, Hy Cetin, and M. Uyar. “The Efficacy of Intrathecal Morphine in Post-Thoracotomy Pain Management.” The Journal of International Medical Research 35, no. 3 (June 2007): 314–22.
3 Bunchungmongkol, Nutchanart, Tanyong Pipanmekaporn, Sahattaya Paiboonworachat, Somcharoen Saeteng, and Apichat Tantraworasin. Incidence and Risk Factors Associated with Ipsilateral Shoulder Pain after Thoracic Surgery. Journal of Cardiothoracic and Vascular Anesthesia 28, no. 4 (August 2014): 979–82. doi:10.1053/j.jvca.2013.10.008.
4 Cason, Molly, Ami Naik, Joshua C. Grimm, David Hanna, Lea Faraone, Jason C. Brookman, Ashish Shah, and Marie N. Hanna. The Efficacy and Safety of Epidural-Based Analgesia in a Case Series of Patients Undergoing Lung Transplantation. Journal of Cardiothoracic and Vascular Anesthesia 29, no. 1 (February 2015): 126–32. doi:10.1053/j.jvca.2014.07.023.
5 Cioffi U, Raveglia F, Rizzi A, et al. Paravertebral analgesia in video-assisted thoracic surgery: A new hybrid technique of catheter placement for continuous anesthetic infusion. The Thoracic and Cardiovascular Surgeon 2015;63(6):533–34. doi:10.1055/s-0034-1396426.
6 Çubuk, Sezai. Is Single Level Paravertebral Analgesia Enough for Controlling Postoperative Pain in VATS? The Thoracic and Cardiovascular Surgeon 63, no. 6 (September 2015): 535–36. doi:10.1055/s-0035-1549361.
7 Elsayed H, Insertion of paravertebral block catheters intraoperatively to reduce incidence of block failure. Interactive Cardiovascular and Thoracic Surgery 2012;14(5):648–49. doi:10.1093/icvts/ivr055.
8 Elsayed, Hany, and Michael Poullis. Should Paravertebral Analgesia Be Used to Fast Track Patients after Thoracic Surgery? European Journal of Cardio-Thoracic Surgery 35, no. 1 (January 1, 2009): 188–188. doi:10.1016/j.ejcts.2008.10.011.  .
9 Elsayed, Hany, James McKevith, James McShane, and Nigel Scawn. Thoracic Epidural or Paravertebral Catheter for Analgesia after Lung Resection: Is the Outcome Different? Journal of Cardiothoracic and Vascular Anesthesia 26, no. 1 (February 2012): 78–82. doi:10.1053/j.jvca.2011.09.019.
10 Engelhardt KE, Starnes SL, Hanseman DJ et al. Epidural versus subpleural analgesia for pulmonary resections: A comparison of morbidities. The American Surgeon 2014;80(2):109–16.
11 García-Tirado, Javier, and Cristina Rieger-Reyes. Suture Techniques of the Intercostal Space in Thoracotomy and Their Relationship with Post-Thoracotomy Pain: A Systematic Review. Archivos De Bronconeumología 48, no. 1 (January 2012): 22–28. doi:10.1016/j.arbres.2011.04.012.
12 Garutti, Ignacio, Federico González-Aragoneses, Maria Teresa Biencinto, Emma Novoa, Carlos Simón, Nicolás Moreno, Patricia Cruz, and Carmen Benito. Thoracic Paravertebral Block after Thoracotomy: Comparison of Three Different Approaches. European Journal of Cardio-Thoracic Surgery 35, no. 5 (May 1, 2009): 829–32. doi:10.1016/j.ejcts.2009.01.025.
13 Goharian, Vahid, Sayyed Abbas Tabatabaee, Sayyed MozafarHashemi, Gholamreza Mohajery, Mohammad Arash Ramezani, Fatemeh Shabani, and Zahra MotevalliEmami. A Comparison between Subpleural Patient-Controlled Analgesia by Bupivacaine and Intermittent Analgesia in Post-Operative Thoracotomy: A Double-Blind Randomized Clinical Trial. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences 16, no. 9 (September 2011): 1210.
14 Goravanchi, Farzin, Spencer S. Kee, Alicia M. Kowalski, Joel S. Berger, and Katy E. French. A Case Series of Thoracic Paravertebral Blocks Using a Combination of Ropivacaine, Clonidine, Epinephrine, and Dexamethasone. Journal of Clinical Anesthesia 24, no. 8 (December 2012): 664–67. doi:10.1016/j.jclinane.2012.05.005.
15 Grishin, V. V., and M. A. Vyzhigina. [Multicomponent general anesthesia using analgesic butorphanol tartrate (beforal) in thoracic surgery]. Anesteziologiia I Reanimatologiia, no. 4 (August 1994): 24–27.  .
16 Ishikawa, Yoshihiro, Takamitsu Maehara, Teppei Nishii, Kazuki Yamanaka, Hiroyuki Adachi, Shizu Saito, and Munetaka Masuda. Intrapleural Analgesia Using Ropivacaine for Postoperative Pain Relief after Minimally Invasive Thoracoscopic Surgery. Annals of Thoracic and Cardiovascular Surgery 18, no. 5 (2012): 429–33. doi:10.5761/atcs.oa.11.01854.
17 Kampe, Sandra, Gerhard Weinreich, Christopher Darr, Kolja Eicker, Georgios Stamatis, and Thomas Hachenberg. The Impact of Epidural Analgesia Compared to Systemic Opioid-Based Analgesia with Regard to Length of Hospital Stay and Recovery of Bowel Function: Retrospective Evaluation of 1555 Patients Undergoing Thoracotomy. Journal of Cardiothoracic Surgery 9 (2014): 175. doi:10.1186/s13019-014-0175-8.
18 Kim SH, Yoon KB, Yoon DM, et al. Patient-controlled epidural analgesia with ropivacaine and fentanyl: experience with 2,276 surgical patients. The Korean Journal of Pain 2013;26(1):39–45. doi:10.3344/kjp.2013.26.1.39.
19 Kobayashi R, Mori S, Wakai K, et al. Paravertebral block via the surgical field versus epidural block for patients undergoing thoracotomy: A randomized clinical trial. Surgery Today 2013;43(9):963–69. doi:10.1007/s00595-012-0485-1.
20 Kolettas, Alexandros, George Lazaridis, Sofia Baka, Ioannis Mpoukovinas, Vasilis Karavasilis, Ioannis Kioumis, Georgia Pitsiou, et al. Postoperative Pain Management. Journal of Thoracic Disease 7, no. Suppl 1 (February 2015): S62–72. doi:10.3978/j.issn.2072-1439.2015.01.15.
21 Komatsu T, Kino A, Inoue M, et al. Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery.” International Journal of Surgery 2014;12(9):936–39.  doi:10.1016/j.ijsu.2014.07.272.
22 Komatsu, Teruya, Terumasa Sowa, Atsunari Kino, and Takuji Fujinaga. The Importance of Pleural Integrity for Effective and Safe Thoracic Paravertebral Block: A Retrospective Comparative Study on Postoperative Pain Control by Paravertebral Block. Interactive Cardiovascular and Thoracic Surgery 20, no. 3 (March 2015): 296–99. doi:10.1093/icvts/ivu395.
23 Kotemane, Naren C., Niraj Gopinath, and Rakesh Vaja. Analgesic Techniques Following Thoracic Surgery: A Survey of United Kingdom Practice. European Journal of Anaesthesiology 27, no. 10 (October 2010): 897–99. doi:10.1097/EJA.0b013e32833d1259.
24 Machino, Asami, Masaki Wakamatsu, Takeshi Kaida, Hiroko Hirano, Yasuichiro Mori, Saeko Yamazaki, Ai Takahashi, Sin Haku, Shouichi Sugaya, and Kouji Kuroda. [Postoperative pain management in video-assisted thoracic surgery using a continuous unilateral intercostal analgesia]. Masui. The Japanese Journal of Anesthesiology 63, no. 12 (December 2014): 1319–23.  .
25 Matsutani, Noriyuki, and Masafumi Kawamura. Successful Management of Postoperative Pain with Pregabalin after Thoracotomy. Surgery Today 44, no. 4 (September 27, 2013): 712–15. doi:10.1007/s00595-013-0743-x.
26 Matyal, Robina, Mario Montealegre-Gallegos, Marc Shnider, Khurram Owais, Sruthi Sakamuri, Omair Shakil, Vipul Shah, John Pawlowski, Sidharta Gangadharan, and Phillip Hess. Preemptive Ultrasound-Guided Paravertebral Block and Immediate Postoperative Lung Function. General Thoracic and Cardiovascular Surgery 63, no. 1 (January 2015): 43–48. doi:10.1007/s11748-014-0442-6.  .
27 Maxwell, Cory, and Alina Nicoara. New Developments in the Treatment of Acute Pain after Thoracic Surgery. Current Opinion in Anaesthesiology 27, no. 1 (February 2014): 6–11. doi:10.1097/ACO.0000000000000029.
28 Mendola, C., G. Cammarota, R. Netto, G. Cecci, A. Pisterna, D. Ferrante, C. Casadio, and F. Della Corte. S+ -Ketamine for Control of Perioperative Pain and Prevention of Post Thoracotomy Pain Syndrome: A Randomized, Double-Blind Study. Minerva Anestesiologica 78, no. 7 (July 2012): 757–66.
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Incusion criteria 4 not fulfilled: other

 

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2 Englbrecht, J. S., and Prof Dr E. M. Pogatzki-Zahn. Perioperative Schmerztherapie bei abdominellen und thorakalen Operationen. Der Schmerz 28, no. 3 (June 7, 2014): 265–81. doi:10.1007/s00482-014-1420-8.
3 Katayama, Tatsuya, Shinji Hirai, Rei Kobayashi, Makoto Hamaishi, Takeshi Okada, and Norimasa Mitsui. “Safety of the Paravertebral Block in Patients Ineligible for Epidural Block Undergoing Pulmonary Resection.” General Thoracic and Cardiovascular Surgery 60, no. 12 (December 2012): 811–14. doi:10.1007/s11748-012-0149-5.