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Updated: Sep 8, 2025

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Intercostal nerve block is superior than erector spinae plane block after uniportal video-assisted thoracoscopic
Shuo-Ying Dai1, Yen-Chin Liu2, Ting-Wei Kang3
1Division of Thoracic Surgery, Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan.
In this double-blinded, randomized controlled trial, sixty patients undergoing elective uniportal video-assisted thoracoscopic surgery (VATS) lobectomy were randomly assigned to receive thoracoscopic intercostal nerve block (ICNB, n = 30) or ultrasound-guided erector spinae plane block (ESPB, n = 30). No block-related adverse events occurred. The ICNB group showed significantly lower resting and coughing visual analog scale scores, than the ESPB group, 4 (4.0 and 5.0 versus 5.0 and 6.0, p = 0.006 and 0.012) and 8 (3.0 and 4.0 versus 5.0 and 6.0, p = 0.003 and 0.017) hours postoperatively. The ESPB group consumed morphine significantly earlier (1.5 versus 10 h, p = 0.002), and had a higher 24-h cumulative consumption (11 versus 7 mg, p = 0.103). No differences were observed in postoperative nausea, vomiting, complications, drainage duration, or hospital stay. ICNB demonstrated superior early analgesic efficacy, whereas ICNB and ESPB depicted safety and facilitated rapid recovery following uniportal VATS lobectomy.
In this double-blinded, randomized controlled trial, sixty patients undergoing elective uniportal video-assisted thoracoscopic surgery (VATS) lobectomy were randomly assigned to receive thoracoscopic intercostal nerve block (ICNB, n = 30) or ultrasound-guided erector spinae plane block (ESPB, n = 30). No block-related adverse events occurred. The ICNB group showed significantly lower resting and coughing visual analog scale scores, than the ESPB group, 4 (4.0 and 5.0 versus 5.0 and 6.0, p = 0.006 and 0.012) and 8 (3.0 and 4.0 versus 5.0 and 6.0, p = 0.003 and 0.017) hours postoperatively. The ESPB group consumed morphine significantly earlier (1.5 versus 10 h, p = 0.002), and had a higher 24-h cumulative consumption (11 versus 7 mg, p = 0.103). No differences were observed in postoperative nausea, vomiting, complications, drainage duration, or hospital stay. ICNB demonstrated superior early analgesic efficacy, whereas ICNB and ESPB depicted safety and facilitated rapid recovery following uniportal VATS lobectomy.
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