Preoperative and postoperative ultrasound guided intercostal nerve blockade on postoperative analgesia in patients...

Ultrasound-guided intercostal nerve block (ICNB) is an effective modality for alleviating pain after video-assisted thoracic surgery (VATS). However, the optimal timing for its administration remains controversial. This study aimed to compare the analgesic efficacy of preoperative versus postoperative ICNB in patients undergoing VATS.

A total of 172 adult patients undergoing VATS were randomized into two parallel groups: the pre-ICNB group (preoperative ultrasound-guided ICNB, n = 88) and the post-ICNB group (postoperative ultrasound-guided ICNB, n = 84). The primary outcome was the incidence of at least one episode of moderate-to-severe pain at rest (Numeric Rating Scale [NRS] score > 4) during the first 24 h postoperatively. Secondary outcomes included NRS scores during coughing, perioperative opioid consumption, sleep quality, and the incidence of postoperative complications.

The incidence of moderate-to-severe resting pain during the first 24 h postoperatively was significantly lower in the post-ICNB group than in the pre-ICNB group (11.9% vs. 28.4%, P < 0.05). Both static (at rest) and dynamic (during coughing) NRS scores were significantly lower in the post-ICNB group at 4, 6 and 8 h postoperatively (P < 0.05); however, comparable pain scores were observed upon admission to the post-anesthesia care unit (PACU) and at 2, 24, and 48 h postoperatively (P > 0.05). Cumulative postoperative opioid consumption at 24 and 48 h was significantly lower in the post-ICNB group (P < 0.01). Furthermore, patients in the post-ICNB group exhibited superior sleep quality during the first two postoperative nights (P < 0.01). No significant differences were observed in total (intraoperative + postoperative) opioid consumption, overall recovery quality, or surgical/anesthetic complications.

Postoperative ICNB provides superior early postoperative analgesia, reduces postoperative opioid requirements, and improves sleep quality compared with preoperative ICNB. These findings suggest that postoperative administration is a more effective strategy for acute pain management following VATS.

https://www.chictr.org.cn/showproj.aspx?proj=183278, identifier ChiCTR2300079183.