Related Experiment Video
Updated: Aug 23, 2026

Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Postoperative analgesia in video-assisted thoracoscopy: the role of intercostal blockade
Ruth Taylor1, Simon Massey, Karen Stuart-Smith
1Department of Anaesthesia, Bristol Royal Infirmary, Bristol, United Kingdom.
Objectives:
This study examined (1) the opioid and nonopioid requirement of patients undergoing video-assisted thoracoscopy (VATS) as a measure of postoperative pain and (2) whether percutaneous intercostal blockade might reduce morphine requirements and improve analgesia in VATS procedures.
Design:
A combined retrospective and prospective study.
Setting:
A university teaching hospital.
Participants:
Patients undergoing VATS procedures.
Interventions:
A retrospective analysis of 26 sequential patients; perioperative intercostal blockade with bupivacaine, either with or without dextran 40, in 26 prospective patients.
Measurements And Main Results:
Retrospective: opioid and nonopioid analgesic requirements of 26 sequential patients who had undergone VATS surgery without intercostal blockade were determined from a study of the case records. Twenty-six additional patients undergoing VATS surgery by the same surgeon were randomly divided to receive either percutaneous intercostal nerve block using plain bupivacaine 0.375% or bupivacaine 0.375% in dextran 40. The duration of local anesthesia was assessed. Postoperative opioid and nonopioid analgesic requirements were compared with the retrospective group.
Conclusions:
Postoperative morphine requirements after VATS surgery are considerable, with pleurectomy being the most painful procedure. Intercostal blockade with bupivacaine provided effective pain relief and a dramatic reduction in morphine requirements. This technique is recommended for VATS surgery, especially if day-case procedures are being contemplated.
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