Effect of General Anesthesia Combined with Single-Shot, Single-Level Thoracic Paravertebral Block on Postoperative Analgesia in Children Undergoing Thoracoscopic Mediastinal Tumor Resection: A Randomized Controlled Trial.

OBJECTIVE

To evaluate whether unilateral, single‑level, ultrasound‑guided thoracic paravertebral block (TPVB) improves postoperative analgesia and early recovery in children undergoing thoracoscopic mediastinal tumor resection.

DESIGN

A prospective, randomized controlled trial.

SETTING

Single center.

PARTICIPANTS

Children age 4 to 12 years scheduled for thoracoscopic mediastinal tumor resection.

INTERVENTIONS: General anesthesia alone (group G; n = 50) or general anesthesia plus a preincision TPVB (group T; n = 51).

MEASUREMENTS AND MAIN

RESULTS

Postoperative pain intensity was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, and quality of recovery was evaluated using the 15-item Quality of Recovery questionnaire (QoR-15). The primary outcome was pain intensity, quantified as the area under the curve of FLACC scores (AUC-FLACC). Secondary outcomes included QoR-15 scores, pain scores at predefined postoperative time points, intraoperative anesthetic requirements, postoperative opioid consumption, and length of hospital stay. AUC‑FLACC over the first 24 hours was lower in group T compared to group G (41.3/240 vs 53.0/240; mean difference (T - G), -11.8; 95% confidence interval, -14.2 to -9.34, p < 0.001]. Pain scores during the first 20 hours were lower in group T, while QoR‑15 scores at 24 hours were higher in group T. Intraoperative anesthetic use, postoperative rescue opioids, and hospital stay were all reduced in group T.

CONCLUSIONS

Single‑shot, single-level TPVB provides early postoperative analgesia in pediatric thoracoscopic mediastinal tumor surgery, enhances short-term recovery, reduces opioid requirements, and does not increase hospital costs or adverse events.