Analgesia for patients undergoing video-assisted thoracic surgery: a survey of Canadian thoracic surgeons

Pain management is an essential part of enhanced recovery after surgery, facilitating early return to mobility and improving respiratory mechanics. Acute pain management guidelines for patients undergoing video-assisted thoracoscopic surgery (VATS) procedures have been published recently. We assessed compliance of Canadian surgeons with those guidelines.

A survey was distributed to all currently practicing Canadian thoracic surgeons through the Canadian Association of Thoracic Surgeons (CATS). The survey included questions about demographics, nerve block techniques, and other analgesics. Responses were scored as not, partially, or fully compliant with Procedure Specific Postoperative Pain Management (PROSPECT) guidelines for nerve blocks and other analgesics.

The response rate was 25% (53 surgeons of 213 CATS members). Most surgeons infiltrated the port sites (83%) and placed intercostal nerve blocks (81%). However, only 16 (30%) respondents complied with guidelines on analgesic nerve blocks and 11 (21%) on analgesic medications. Ten (19%) respondents use a thoracic epidural. None of the respondents were in full compliance with the guidelines.

Epidural analgesia is still commonly used despite the recommendation against their use. Epidurals are not superior to other blocks in terms of effectiveness but have a higher rate of complications. Only 30% offered one of the recommended blocks. The presence of a dedicated block room was associated with offering recommended blocks and overall nerve block compliance. The current survey did not capture barriers to regional anesthesia, or knowledge of the guidelines. While there is improvement compared to a prior survey, there is low overall compliance with pain management guidelines.