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One RCT of a small sample of TS lobectomies (n=52) reported equivocal findings for the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects when EA using 0.2% ropivacaine with fentanyl was compared with intravenous (IV) patient-controlled analgesia using fentanyl and ketorolac (6). Another RCT of a small sample of TS lobectomies and wedge resections (n=46) reported that EA is effective for pain control until one postoperative day after TS, particularly for pain during movement. However, that study reported that EA causes nausea/vomiting in some patients when EA using 0.1% bupivacaine with fentanyl was compared with non-EA involving diclofenac, pentazocine, and loxoprofen (7). A recent RCT of a small number of predominant TS wedge resections (n=62) reported equivocal findings for pain relief when EA and INB using both ropivacaine was compared (8). Although these studies were small number referring to the use of EA after TS, it should be impossible to determine the definitive conclusion. One review commented that on the basis of available data, EA is likely not necessary for patients undergoing TS, and situations in which EA may be considered include a high likelihood of conversion to thoracotomy and an opioid-tolerant patient (2).

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