Omair Shakil - Academia.edu (original) (raw)

Papers by Omair Shakil

Research paper thumbnail of Revised Trauma Score as a Predictor of Outcome in Trauma Cases: Experiences at a Tertiary Care Hospital in Karachi, Pakistan

Journal of Ayub Medical College, Abbottabad : JAMC

Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised ... more Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised Trauma Score (RTS) is widely used internationally but its effectiveness as a tool for predicting outcome in paediatric trauma patients in our setting, has yet to be established, mainly owing to lack of use. The aim of this study was to determine the effectiveness of RTS as a predictor of outcome in paediatric trauma patients in Pakistan. We conducted a retrospective review of patient medical records at Aga Khan University Hospital, Karachi, from October 2006 to October 2009 and all patients aged less than 14 years, presenting with trauma were selected. Information was collected regarding demographics, vital signs at the time of presentation, length of stay (LOS) in the ward, ICU and the hospital, complications during hospital stay and mortality. Data was analysed in SPSS-17.0. The sample was 501 patients with a mean age of 5.3 years. Two third (66%) were males and 34% were females. Using...

Research paper thumbnail of The role of computed tomography for identifying mechanical bowel obstruction in a Pakistani population

JPMA. The Journal of the Pakistan Medical Association, 2011

To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically... more To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction. It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was analyzed using SPSS version 16.0. A total of 271 patient records were reviewed. The mean age was 46 +/- 19 years and (64%) were men. Mechanical intestinal obstruction was found in 104 patients on laparotomy and CT scan had diagnosed 97 of these. The sensitivity and specificity was 93% respectively. CT scanning correctly identified the cause of the obstruc...

Research paper thumbnail of Impact of gender and body surface area on outcome after abdominal aortic aneurysm repair

The American Journal of Surgery, 2015

A gender-neutral threshold aneurysm diameter (AD) of more than 5.5 cm for surgical intervention i... more A gender-neutral threshold aneurysm diameter (AD) of more than 5.5 cm for surgical intervention in abdominal aortic aneurysms (AAA) ignores the fact that women have a smaller baseline AD. We hypothesized that women have a greater AD relative to body surface area (BSA) at the time of surgery and that this worsens outcome. The Vascular Study Group of New England database was queried for elective AAA repairs performed from 2003 to 2011 to compare BSA-indexed AD, ie, aortic size index (ASI), between men and women at the time of surgery and the impact of ASI on outcome. Women were older and had higher ASI among both open-repair (n = 1,566) and endovascular repair (n = 2,172) patients (P < .001). Among open-repair patients, mean ASI for men undergoing repair at AD of 5.5 cm (2.75 cm/m²) was used to subdivide women into 2 categories: women with ASI of 2.75 or more were older (P < .001), had a larger aneurysm size (P < .001), and had a higher 1-year mortality (P = .042) than women with ASI less than 2.75. When indexed to BSA, women have a larger aneurysm size than men at the time of AAA repair.

Research paper thumbnail of Endovascular Repair of a Right-sided Aortic Arch Aneurysm and Tracheal Injury

Journal of Bronchology & Interventional Pulmonology, 2014

Implications of an aortic arch endoprosthesis on tracheal anatomy are underrecognized, especially... more Implications of an aortic arch endoprosthesis on tracheal anatomy are underrecognized, especially given their close anatomic relationship. We present a unique case of an elderly woman who suffered an iatrogenic tracheal injury due to both an aberrant aortic arch anatomy and a thoracic endoprosthesis.

Research paper thumbnail of Repair of a Full-Thickness Tracheal Tear Using Cardiopulmonary Bypass

Journal of Bronchology & Interventional Pulmonology, 2013

Research paper thumbnail of Health-care associated infections in children after cardiac surgery in a pediatric cardiac intensive care unit (PCICU)

The Journal of Infection in Developing Countries, 2011

Key words: health-care associated infections (HAIs); cardiac intensive care unit (CICU); pediatri... more Key words: health-care associated infections (HAIs); cardiac intensive care unit (CICU); pediatric cardiac surgery J Infect Dev Ctries 2011; 5(10):748-750.

Research paper thumbnail of Systolic Anterior Motion of the Mitral Valve and Three-Dimensional Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia, 2013

D YNAMIC LEFT VENTRICULAR outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) ... more D YNAMIC LEFT VENTRICULAR outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) of the mitral valve (MV) after MV repair is a well-known phenomenon. 1 Clinically significant SAM can cause LVOT obstruction and hemodynamic instability regardless of the presence of mitral regurgitation (MR). Two-dimensional (2D) transesophageal echocardiographic (TEE) appearance of dynamic LVOT obstruction consists of SAM, turbulence on color-flow Doppler in the LVOT, and eccentric mitral regurgitation. In MV repairs complicated with SAM, MV replacement is considered the definitive treatment. 1 Therefore, echocardiographic exclusion of clinically significant SAM is an integral component of post-MV repair TEE examination. The authors present a case of MV repair that was complicated by post-repair SAM and hemodynamic instability. Real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to diagnose the partial nature of the occlusion of the LVOT.

Research paper thumbnail of Percutaneous Closure of an Atrial Septal Defect and 3-Dimensional Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia, 2013

A N OTHERWISE HEALTHY 50-year-old man was scheduled for percutaneous atrial septal defect (ASD) c... more A N OTHERWISE HEALTHY 50-year-old man was scheduled for percutaneous atrial septal defect (ASD) closure with an Amplatzer Septal Occluder (AGA Medical Corp, Plymouth, MN). The patient initially had presented to an outside hospital 1 year earlier with an episode of chest pain at rest. A chest x-ray performed during that admission showed a widened mediastinum. A subsequent computed tomography scan and transthoracic echocardiogram (TTE) revealed a 2.1-cm wide secundum ASD with a dilated right ventricle and moderately dilated right and left atria. The patient did not follow through with recommendations for a TEE and possible ASD closure and was lost to follow-up. A year later, he returned to the authors' institution with a 6-month long history of dyspnea and episodic chest pain with moderate exertion that was relieved by rest. He underwent cardiac catheterization to assess for the presence of coronary artery disease, but which was negative for any flow-limiting lesions. Resting hemodynamics revealed normal right-sided pressures, and oxygen saturation measurements that were consistent with a left-to-right shunt (Qp/Qs ϭ 2.4). He subsequently was referred for ASD closure under TEE guidance. After an uneventful induction of general anesthesia, a TEE examination was performed using an IE-33 Ultrasound System X7-2E Probe (Philips Medical Systems, Andover, MA) capable of real-time 3-dimensional (3D) imaging.

Research paper thumbnail of An Incidental Finding During Emergent Vascular Surgery: How Far to Go?

Journal of Cardiothoracic and Vascular Anesthesia, 2012

Research paper thumbnail of Simulation Training in Echocardiography: The Evolution of Metrics

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Mitral Annulus: An Intraoperative Echocardiographic Perspective

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Major Surgery, Hemodynamic Instability, and a Left Atrial Appendage Clot: What to Do?

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Traumatic right ventricular aneurysm and ventricular tachycardia

Research paper thumbnail of Impact of Three-Dimensional Echocardiography on Classification of the Severity of Aortic Stenosis

The Annals of Thoracic Surgery, 2013

Owing to its elliptical shape, the left ventricle outflow tract (LVOT) area is underestimated by ... more Owing to its elliptical shape, the left ventricle outflow tract (LVOT) area is underestimated by two-dimensional (2D) diameter-based calculations which assume a circular shape. This results in overestimation of aortic stenosis (AS) by the continuity equation. In cases of moderate to severe AS, this overestimation can affect intraoperative clinical decision making (expectant management versus replacement). The purpose of this intraoperative study was to compare the aortic valve area calculated by 2D diameter based and three-dimensional (3D) derived LVOT area via transesophageal echocardiography (TEE) and its impact on severity of AS. The LVOT area was calculated using intraoperative 2D and 3D TEE data from patients undergoing aortic valve replacement (AVR) and coronary artery bypass graft (CABG) surgery using the 2D diameter (RADIUS), 3D planimetry (PLANE), and 3D biplane (π·x·y) measurement (ELLIPSE) methods. For each method, the LVOT area was used to determine the aortic valve area by the continuity equation and the severity of AS categorized as mild, moderate, or severe. A total of 66 patients completed the study. The RADIUS method (3.5 ± 0.9 cm(2)) underestimated LVOT area by 21% (p < 0.05) compared with the PLANE method (4.1 ± 0.1 cm(2)) and by 18% (p < 0.05) compared with the ELLIPSE method (4.0 ± 0.9 cm(2)). There was no significant difference between the two 3D methods, namely, PLANE and ELLIPSE. Seven AVR patients (18%) and 1 CABG surgery patient (6%) who had originally been classified as severe AS by the 2D method were reclassified as moderate AS by the 3D methods (p < 0.001). Three-dimensional echocardiography has the potential to impact surgical decision making in cases of moderate to severe AS.

Research paper thumbnail of Intracardiac Wegener's Granulomatosis

The Annals of Thoracic Surgery, 2012

Research paper thumbnail of Dynamic 3-Dimensional Echocardiographic Assessment of Mitral Annular Geometry in Patients With Functional Mitral Regurgitation

The Annals of Thoracic Surgery, 2013

Background. Mitral valve (MV) annular dynamics have been well described in animal models of funct... more Background. Mitral valve (MV) annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV annular geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV annular geometry associated with FMR.

Research paper thumbnail of Unicommissural unicuspid aortic valve

Annals of Cardiac Anaesthesia, 2014

Research paper thumbnail of Can Propofol Mimic Alcohol-related Pain in Patients with Hodgkin Lymphoma?

Research paper thumbnail of Preemptive ultrasound-guided paravertebral block and immediate postoperative lung function

General Thoracic and Cardiovascular Surgery, 2014

The aim of this study was to investigate the effects of preemptive ultrasound-guided thoracic par... more The aim of this study was to investigate the effects of preemptive ultrasound-guided thoracic paravertebral block versus intercostal block on postoperative respiratory function and pain control in patients undergoing video-assisted thoracoscopic surgery. 50 consecutive patients undergoing video-assisted thoracoscopic surgery. A prospective cohort of patients who received either ultrasound-guided thoracic paravertebral block immediately before the procedure or intercostal block placed by the surgeon at the end of the procedure were studied. Pulmonary function was assessed before surgery and 4 h postoperatively. Pain was assessed with the visual analog scale at 2 and 4 h after surgery both at rest and on coughing. 30 patients on the paravertebral block group and 20 on the intercostal block group were studied. Forced vital capacity (p < 0.001), forced expiratory volume at 1 s (p < 0.001) and forced expiratory flow 25-75% (p = 0.001) were significantly higher at 4 h with paravertebral block compared to the intercostal block group. The visual analog score for pain was significantly improved with paravertebral block at rest (p < 0.05) and with cough (p = 0.00). Perioperative narcotic use was significantly reduced with paravertebral block in comparison to intercostal block (p = 0.04). When compared to intercostal blocks, ultrasound-guided thoracic paravertebral block appears to preserve lung function and provide better pain control in the immediate postoperative period after video-assisted thoracoscopic surgery.

Research paper thumbnail of Revised Trauma Score as a Predictor of Outcome in Trauma Cases: Experiences at a Tertiary Care Hospital in Karachi, Pakistan

Journal of Ayub Medical College, Abbottabad : JAMC

Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised ... more Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised Trauma Score (RTS) is widely used internationally but its effectiveness as a tool for predicting outcome in paediatric trauma patients in our setting, has yet to be established, mainly owing to lack of use. The aim of this study was to determine the effectiveness of RTS as a predictor of outcome in paediatric trauma patients in Pakistan. We conducted a retrospective review of patient medical records at Aga Khan University Hospital, Karachi, from October 2006 to October 2009 and all patients aged less than 14 years, presenting with trauma were selected. Information was collected regarding demographics, vital signs at the time of presentation, length of stay (LOS) in the ward, ICU and the hospital, complications during hospital stay and mortality. Data was analysed in SPSS-17.0. The sample was 501 patients with a mean age of 5.3 years. Two third (66%) were males and 34% were females. Using...

Research paper thumbnail of The role of computed tomography for identifying mechanical bowel obstruction in a Pakistani population

JPMA. The Journal of the Pakistan Medical Association, 2011

To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically... more To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction. It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was analyzed using SPSS version 16.0. A total of 271 patient records were reviewed. The mean age was 46 +/- 19 years and (64%) were men. Mechanical intestinal obstruction was found in 104 patients on laparotomy and CT scan had diagnosed 97 of these. The sensitivity and specificity was 93% respectively. CT scanning correctly identified the cause of the obstruc...

Research paper thumbnail of Impact of gender and body surface area on outcome after abdominal aortic aneurysm repair

The American Journal of Surgery, 2015

A gender-neutral threshold aneurysm diameter (AD) of more than 5.5 cm for surgical intervention i... more A gender-neutral threshold aneurysm diameter (AD) of more than 5.5 cm for surgical intervention in abdominal aortic aneurysms (AAA) ignores the fact that women have a smaller baseline AD. We hypothesized that women have a greater AD relative to body surface area (BSA) at the time of surgery and that this worsens outcome. The Vascular Study Group of New England database was queried for elective AAA repairs performed from 2003 to 2011 to compare BSA-indexed AD, ie, aortic size index (ASI), between men and women at the time of surgery and the impact of ASI on outcome. Women were older and had higher ASI among both open-repair (n = 1,566) and endovascular repair (n = 2,172) patients (P < .001). Among open-repair patients, mean ASI for men undergoing repair at AD of 5.5 cm (2.75 cm/m²) was used to subdivide women into 2 categories: women with ASI of 2.75 or more were older (P < .001), had a larger aneurysm size (P < .001), and had a higher 1-year mortality (P = .042) than women with ASI less than 2.75. When indexed to BSA, women have a larger aneurysm size than men at the time of AAA repair.

Research paper thumbnail of Endovascular Repair of a Right-sided Aortic Arch Aneurysm and Tracheal Injury

Journal of Bronchology & Interventional Pulmonology, 2014

Implications of an aortic arch endoprosthesis on tracheal anatomy are underrecognized, especially... more Implications of an aortic arch endoprosthesis on tracheal anatomy are underrecognized, especially given their close anatomic relationship. We present a unique case of an elderly woman who suffered an iatrogenic tracheal injury due to both an aberrant aortic arch anatomy and a thoracic endoprosthesis.

Research paper thumbnail of Repair of a Full-Thickness Tracheal Tear Using Cardiopulmonary Bypass

Journal of Bronchology & Interventional Pulmonology, 2013

Research paper thumbnail of Health-care associated infections in children after cardiac surgery in a pediatric cardiac intensive care unit (PCICU)

The Journal of Infection in Developing Countries, 2011

Key words: health-care associated infections (HAIs); cardiac intensive care unit (CICU); pediatri... more Key words: health-care associated infections (HAIs); cardiac intensive care unit (CICU); pediatric cardiac surgery J Infect Dev Ctries 2011; 5(10):748-750.

Research paper thumbnail of Systolic Anterior Motion of the Mitral Valve and Three-Dimensional Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia, 2013

D YNAMIC LEFT VENTRICULAR outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) ... more D YNAMIC LEFT VENTRICULAR outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) of the mitral valve (MV) after MV repair is a well-known phenomenon. 1 Clinically significant SAM can cause LVOT obstruction and hemodynamic instability regardless of the presence of mitral regurgitation (MR). Two-dimensional (2D) transesophageal echocardiographic (TEE) appearance of dynamic LVOT obstruction consists of SAM, turbulence on color-flow Doppler in the LVOT, and eccentric mitral regurgitation. In MV repairs complicated with SAM, MV replacement is considered the definitive treatment. 1 Therefore, echocardiographic exclusion of clinically significant SAM is an integral component of post-MV repair TEE examination. The authors present a case of MV repair that was complicated by post-repair SAM and hemodynamic instability. Real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to diagnose the partial nature of the occlusion of the LVOT.

Research paper thumbnail of Percutaneous Closure of an Atrial Septal Defect and 3-Dimensional Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia, 2013

A N OTHERWISE HEALTHY 50-year-old man was scheduled for percutaneous atrial septal defect (ASD) c... more A N OTHERWISE HEALTHY 50-year-old man was scheduled for percutaneous atrial septal defect (ASD) closure with an Amplatzer Septal Occluder (AGA Medical Corp, Plymouth, MN). The patient initially had presented to an outside hospital 1 year earlier with an episode of chest pain at rest. A chest x-ray performed during that admission showed a widened mediastinum. A subsequent computed tomography scan and transthoracic echocardiogram (TTE) revealed a 2.1-cm wide secundum ASD with a dilated right ventricle and moderately dilated right and left atria. The patient did not follow through with recommendations for a TEE and possible ASD closure and was lost to follow-up. A year later, he returned to the authors' institution with a 6-month long history of dyspnea and episodic chest pain with moderate exertion that was relieved by rest. He underwent cardiac catheterization to assess for the presence of coronary artery disease, but which was negative for any flow-limiting lesions. Resting hemodynamics revealed normal right-sided pressures, and oxygen saturation measurements that were consistent with a left-to-right shunt (Qp/Qs ϭ 2.4). He subsequently was referred for ASD closure under TEE guidance. After an uneventful induction of general anesthesia, a TEE examination was performed using an IE-33 Ultrasound System X7-2E Probe (Philips Medical Systems, Andover, MA) capable of real-time 3-dimensional (3D) imaging.

Research paper thumbnail of An Incidental Finding During Emergent Vascular Surgery: How Far to Go?

Journal of Cardiothoracic and Vascular Anesthesia, 2012

Research paper thumbnail of Simulation Training in Echocardiography: The Evolution of Metrics

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Mitral Annulus: An Intraoperative Echocardiographic Perspective

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Major Surgery, Hemodynamic Instability, and a Left Atrial Appendage Clot: What to Do?

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Traumatic right ventricular aneurysm and ventricular tachycardia

Research paper thumbnail of Impact of Three-Dimensional Echocardiography on Classification of the Severity of Aortic Stenosis

The Annals of Thoracic Surgery, 2013

Owing to its elliptical shape, the left ventricle outflow tract (LVOT) area is underestimated by ... more Owing to its elliptical shape, the left ventricle outflow tract (LVOT) area is underestimated by two-dimensional (2D) diameter-based calculations which assume a circular shape. This results in overestimation of aortic stenosis (AS) by the continuity equation. In cases of moderate to severe AS, this overestimation can affect intraoperative clinical decision making (expectant management versus replacement). The purpose of this intraoperative study was to compare the aortic valve area calculated by 2D diameter based and three-dimensional (3D) derived LVOT area via transesophageal echocardiography (TEE) and its impact on severity of AS. The LVOT area was calculated using intraoperative 2D and 3D TEE data from patients undergoing aortic valve replacement (AVR) and coronary artery bypass graft (CABG) surgery using the 2D diameter (RADIUS), 3D planimetry (PLANE), and 3D biplane (π·x·y) measurement (ELLIPSE) methods. For each method, the LVOT area was used to determine the aortic valve area by the continuity equation and the severity of AS categorized as mild, moderate, or severe. A total of 66 patients completed the study. The RADIUS method (3.5 ± 0.9 cm(2)) underestimated LVOT area by 21% (p < 0.05) compared with the PLANE method (4.1 ± 0.1 cm(2)) and by 18% (p < 0.05) compared with the ELLIPSE method (4.0 ± 0.9 cm(2)). There was no significant difference between the two 3D methods, namely, PLANE and ELLIPSE. Seven AVR patients (18%) and 1 CABG surgery patient (6%) who had originally been classified as severe AS by the 2D method were reclassified as moderate AS by the 3D methods (p < 0.001). Three-dimensional echocardiography has the potential to impact surgical decision making in cases of moderate to severe AS.

Research paper thumbnail of Intracardiac Wegener's Granulomatosis

The Annals of Thoracic Surgery, 2012

Research paper thumbnail of Dynamic 3-Dimensional Echocardiographic Assessment of Mitral Annular Geometry in Patients With Functional Mitral Regurgitation

The Annals of Thoracic Surgery, 2013

Background. Mitral valve (MV) annular dynamics have been well described in animal models of funct... more Background. Mitral valve (MV) annular dynamics have been well described in animal models of functional mitral regurgitation (FMR). Despite this, little if any data exist regarding the dynamic MV annular geometry in humans with FMR. In the current study we hypothesized that 3-dimensional (3D) echocardiography, in conjunction with commercially available software, could be used to quantify the dynamic changes in MV annular geometry associated with FMR.

Research paper thumbnail of Unicommissural unicuspid aortic valve

Annals of Cardiac Anaesthesia, 2014

Research paper thumbnail of Can Propofol Mimic Alcohol-related Pain in Patients with Hodgkin Lymphoma?

Research paper thumbnail of Preemptive ultrasound-guided paravertebral block and immediate postoperative lung function

General Thoracic and Cardiovascular Surgery, 2014

The aim of this study was to investigate the effects of preemptive ultrasound-guided thoracic par... more The aim of this study was to investigate the effects of preemptive ultrasound-guided thoracic paravertebral block versus intercostal block on postoperative respiratory function and pain control in patients undergoing video-assisted thoracoscopic surgery. 50 consecutive patients undergoing video-assisted thoracoscopic surgery. A prospective cohort of patients who received either ultrasound-guided thoracic paravertebral block immediately before the procedure or intercostal block placed by the surgeon at the end of the procedure were studied. Pulmonary function was assessed before surgery and 4 h postoperatively. Pain was assessed with the visual analog scale at 2 and 4 h after surgery both at rest and on coughing. 30 patients on the paravertebral block group and 20 on the intercostal block group were studied. Forced vital capacity (p < 0.001), forced expiratory volume at 1 s (p < 0.001) and forced expiratory flow 25-75% (p = 0.001) were significantly higher at 4 h with paravertebral block compared to the intercostal block group. The visual analog score for pain was significantly improved with paravertebral block at rest (p < 0.05) and with cough (p = 0.00). Perioperative narcotic use was significantly reduced with paravertebral block in comparison to intercostal block (p = 0.04). When compared to intercostal blocks, ultrasound-guided thoracic paravertebral block appears to preserve lung function and provide better pain control in the immediate postoperative period after video-assisted thoracoscopic surgery.