Vol 72, No 2 (2021)
Original paper
Published online: 2021-01-11

open access

Page views 1254
Article views/downloads 816
Get Citation

Connect on Social Media

Connect on Social Media

An assessment of the effectiveness of regional analgesia after VATS measured by an objective method for assessing testosterone, cortisol, α-amylase, sIgA, and β-endorphin levels — a randomised controlled trial

Szymon Bialka1, Magdalena Sliwczynska1, Aleksandra Marciniak1, Damian Czyzewski2, Hanna Misiolek1
Pubmed: 33619708
Endokrynol Pol 2021;72(2):133-142.


Introduction: Thoracic surgeries are associated with intense postoperative pain. General opioid analgesia is still the main anaesthetic method. Due to the large number of opioid-induced side effects, alternative methods of pain relief are sought. One of them is the use of balanced analgesia, which consists of regional analgesia, non-opioid painkillers, and small doses of opioids.

Material and methods: The objective of this study was to assess the effectiveness of preoperative thoracic paravertebral block (ThPVB) in the treatment of postoperative pain after video-assisted thoracic surgery (VATS) by measuring hormone levels in blood serum or saliva. It was a randomised, open-label study conducted in a single university hospital setting between May 2018 and September 2019. In total, 119 patients were scheduled for elective video-assisted thoracic surgery. Performed interventions included: preoperative thoracic paravertebral block with 0.5% bupivacaine, followed by postoperative oxycodone combined with nonopioid analgesics. Follow-up period comprised first 24 hours and one, two, and six months after surgery. Main outcomes were measured by pain intensity assessed using the Numerical Rating Scale (NRS) and the levels of the following hormones: testosterone, cortisol, α-amylase activity, sIgA, and β-endorphin.

Results: A total of 119 patients were randomised into two groups and, of these, 49 were subsequently excluded from the analysis. The final analysis included 37 patients from the study group and 33 from the control group. There were no statistically significant differences in the analysed parameters the relative change T1–T0. There was a tendency towards statistical significance in the relative change T2–T0 in testosterone levels. At rest, no statistically significant differences were found between groups and time in the percentage of patients with NRS ≥ 1. During cough, the percentage of patients with NRS ≥ 1 was higher at T1 and T2 time points in the ThPVB group. Of the factors considered, only α-amylase levels statistically significantly increased the chance for higher NRS score after a month [OR = 1.013; 95% PU: 1.001–1.025; p < 0.01].

Conclusions: ThPVB is effective and safe for patients undergoing VATS. It can be an effective alternative for general anaesthesia using high doses of opioids.

Article available in PDF format

View PDF Download PDF file


  1. Bochenek A, Reicher M. Anatomia człowieka. Tom 2. PZWL Wydawnictwo Lekarskie, Warszawa 1965.
  2. Wordliczek J, Dobrogowski J. Patofizjologia bólu pooperacyjnego. Przegl Lek. 2000; 57: 201–210.
  3. Misiołek H, Zajączkowska R, Daszkiewicz A, et al. Postoperative pain management - 2018 consensus statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy, the Polish Society of Regional Anaesthesia and Pain Therapy, the Polish Association for the Study of Pain and the National Consultant in Anaesthesiology and Intensive Therapy. Anaesthesiol Intensive Ther. 2018; 50(3): 173–199.
  4. Long H, Tan Q, Luo Q, et al. Thoracoscopic Surgery Versus Thoracotomy for Lung Cancer: Short-Term Outcomes of a Randomized Trial. Ann Thorac Surg. 2018; 105(2): 386–392.
  5. Copik M, Bialka S, Daszkiewicz A, et al. Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial. Eur J Anaesthesiol. 2017; 34(9): 596–601.
  6. D'Ercole F, Arora H, Kumar PA. Paravertebral Block for Thoracic Surgery. J Cardiothorac Vasc Anesth. 2018; 32(2): 915–927.
  7. Sprouse-Blum AS, Smith G, Sugai D, et al. Understanding endorphins and their importance in pain management. Hawaii Med J. 2010; 69(3): 70–71.
  8. Elkhamisy E, Khalel M, Elbioumy A, et al. Beta-endorphin levels in both painful and painless diabetic peripheral neuropathy and its relations to pain characters and severity. Clin Diabetol. 2017; 6(5): 159–171.
  9. Andrade Cde, Galvão-Moreira L, Oliveira Jde, et al. Salivary biomarkers for caries susceptibility and mental stress in individuals with facial pain. Cranio. 2019: 1–7.
  10. Stefaniak A, Kaczmarek U. Salivary α-Amylase and Cortisol as Stress Biomarkers — Literature Review. Dent Med Probl 2013; 50. ; 3: 271–274.
  11. Afrisham R, Sadegh-Nejadi S, SoliemaniFar O, et al. Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students. Psychiatry Investig. 2016; 13(6): 637–643.
  12. Basaria S, Travison TG, Alford D, et al. Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial. Pain. 2015; 156(2): 280–288.
  13. Terheggen MA, Wille F, Borel Rinkes IH, et al. Paravertebral blockade for minor breast surgery. Anesth Analg. 2002; 94(2): 355–9, table of contents.
  14. Hu Z, Liu D, Wang ZZ, et al. The efficacy of thoracic paravertebral block for thoracoscopic surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018; 97(51): e13771.
  15. Zhang W, Fang C, Li J, et al. Single-dose, bilateral paravertebral block plus intravenous sufentanil analgesia in patients with esophageal cancer undergoing combined thoracoscopic-laparoscopic esophagectomy: a safe and effective alternative. J Cardiothorac Vasc Anesth. 2014; 28(4): 966–972.
  16. 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(5): 639–643.
  17. Casati A, Alessandrini P, Nuzzi M, et al. A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery. Eur J Anaesthesiol. 2006; 23(12): 999–1004.
  18. Haager B, Schmid D, Eschbach J, et al. Regional versus systemic analgesia in video-assisted thoracoscopic lobectomy: a retrospective analysis. BMC Anesthesiol. 2019; 19(1): 183.
  19. Miecznikowski W, Kiczmer P, Seńkowska AP, et al. Comparison of two methods of cervical spine pain manual therapy using clinical and biochemical pain markers. Med Res J. 2019; 4(3): 163–170.
  20. Chen ZY, Wang H, Xu W, et al. Effect of intravenous general anaesthesia with epidural block on the expression of pre-endogenous opioid peptide genes. J Int Med Res. 2014; 42(3): 765–772.
  21. Shirasaki S, Fujii H, Takahashi M, et al. Correlation between salivary alpha-amylase activity and pain scale in patients with chronic pain. Reg Anesth Pain Med. 2007; 32(2): 120–123.
  22. Yardeni IZ, Shavit Y, Bessler H, et al. Comparison of postoperative pain management techniques on endocrine response to surgery: a randomised controlled trial. Int J Surg. 2007; 5(4): 239–243.
  23. Friedrich M, Rixecker D, Friedrich G. Evaluation of stress-related hormones after surgery. Clin Exp Obstet Gynecol. 1999; 26(2): 71–75.
  24. Harukuni I, Yamaguchi H, Sato S, et al. The comparison of epidural fentanyl, epidural lidocaine, and intravenous fentanyl in patients undergoing gastrectomy. Anesth Analg. 1995; 81(6): 1169–1174.