Patient-Controlled Paravertebral Block for Video-Assisted Thoracic Surgery: A Randomized Trial

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Pain Management

Background:

• Paravertebral block (PVB) is an effective method for managing postoperative pain following thoracotomy.
• This study investigates patient-controlled PVB versus intravenous patient-controlled analgesia (PCA) for 3-port single-intercostal video-assisted thoracic surgery.

Purpose of the Study:

• To compare the efficacy and safety of patient-controlled PVB against intravenous PCA for postoperative pain control.
• To evaluate pain levels, rescue medication requirements, and adverse events in patients undergoing video-assisted thoracic surgery.

Main Methods:

• A randomized study involving 171 patients undergoing single-intercostal video-assisted thoracic surgery.
• Patients were allocated to either patient-controlled PVB or intravenous PCA groups.
• Pain was assessed using the visual analog score, with intramuscular dezocine as rescue medication.

Main Results:

• No significant difference in mean visual analog scores between PVB and PCA groups (p = 0.115).
• The PVB group required significantly lower cumulative dezocine doses (21.7 mg vs 30.9 mg, p = 0.001).
• PVB group showed significantly lower frequencies of severe vomiting (p = 0.003) and hypotension (p = 0.005).

Conclusions:

• Patient-controlled PVB provides effective pain relief for video-assisted thoracic surgery.
• PVB leads to reduced reliance on rescue analgesics and fewer adverse effects compared to PCA.
• PVB is a beneficial alternative for postoperative pain management in this patient population.