Single versus multisite intercostal nerve block for post-thoracoscopic pain: a prospective observational study

The analgesic efficacy of intercostal nerve block (ICNB) in adults undergoing thoracic surgery and the optimal extent of nerve block remain unclear. To evaluate the analgesic efficacy of ICNB and the optimal extent of nerve block in adults undergoing thoracoscopic surgery, we conducted a prospective cohort study of post-thoracoscopic pain.

We conducted a prospective observational cohort study to assess the postoperative pain intensity scores and other relevant factors associated with different ICNB techniques for pain management in thoracoscopic surgery in a tertiary hospital in Beijing, China. Postoperative pain management was categorized into three groups: the ICNB single-site injection (ICNB SI) group, in which the third to fifth intercostal nerves were blocked with 1 mL of 0.5% ropivacaine at each costal level; the ICNB incision-specific multi-site injection (ICNB ISMSI) group, in which the third to eighth intercostal nerves were blocked with 1 mL of 0.5% ropivacaine at each costal level; and the non-ICNB anesthesia group, which did not undergo any block.

Pain intensity scores (visual analog scale, VAS) in the ICNB SI group were significantly lower than those in the ICNB ISMSI group within 24 hours after surgery (4.9±2.4 vs. 6.2±2.0). Within 24 hours after surgery (day 0), no significant difference in pain intensity scores was observed between the ICNB ISMSI group and the non-ICNB group (6.2±2.0 vs. 6.3±2.1). Additionally, ICNB was effective in reducing pain following thoracoscopic surgery, with analgesic effects lasting up to 4 days postoperatively. Long-term follow-up showed lower incidence of chronic chest pain and better quality of life (QL-Index) in the ICNB groups compared to the non-ICNB group (QL-Index scores: 9.18±0.7 at 3 months in the ICNB group vs. 8.67±0.5 in the non-ICNB group).

Thoracic incision-specific multi-site injections were not superior to single injections of ICNB in terms of post-thoracoscopic analgesia. The single-injection approach (ICNB SI) maintained analgesia for 4 days after thoracoscopic surgery, while the multisite injection (ICNB ISMSI) did not demonstrate this prolonged effect. Further research is needed to elucidate the exact mechanisms underlying these differential analgesic effects in clinical practice.