Thoracoscopy-Guided vs. Ultrasound-Guided Paravertebral Block in Thoracoscopic Surgery: A Non-Inferiority Randomized...

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Pain Management

Background:

• Thoracic paravertebral block (TPVB) is crucial for multimodal analgesia and enhanced recovery after thoracoscopic lung resection.
• A surgeon-performed, thoracoscopy-guided TPVB (T-TPVB) may optimize intraoperative workflow, but comparative data are limited.

Purpose of the Study:

• To determine if T-TPVB is non-inferior to ultrasound-guided TPVB (U-TPVB) for early postoperative pain management.
• To compare pain scores, opioid consumption, complications, and procedural times between T-TPVB and U-TPVB.

Main Methods:

• A single-center, randomized, non-inferiority trial involving adult patients undergoing thoracoscopic lobectomy or segmentectomy.
• Patients received either T-TPVB by surgeons or U-TPVB by anesthesiologists at T4 and T7 levels post-surgery.
• Primary outcome: dynamic pain during coughing (VAS) at 1-6 hours postoperatively.

Main Results:

• T-TPVB was non-inferior to U-TPVB, with comparable mean dynamic VAS scores (3.3 vs. 3.1) at 1-6 hours.
• Secondary outcomes, including pain trajectories and opioid consumption over 48 hours, were similar between groups.
• T-TPVB significantly reduced procedural time without increasing complication rates.

Conclusions:

• Surgeon-performed T-TPVB is a safe and effective alternative to U-TPVB for early postoperative pain control after thoracoscopic lung resection.
• T-TPVB streamlines perioperative workflows and supports enhanced recovery protocols in thoracic surgery.
• Both techniques offer comparable analgesic efficacy and safety.