Ultrasound-guided unilateral thoracic paravertebral block for postoperative analgesia in pediatric patients undergoing thoracoscopic mediastinal tumor resection: a single-center randomized controlled trial.

BACKGROUND: Thoracic paravertebral block (TPVB) has rarely been reported for pediatric mediastinal tumor surgery. This study aimed to evaluate the efficacy of unilateral TPVB for postoperative analgesia in children undergoing thoracoscopic mediastinal tumor resection, providing a potential option for multimodal analgesia in pediatric thoracic oncology surgery. METHODS: Children aged 4 to 12 years scheduled for thoracoscopic mediastinal tumor resection were enrolled and randomly assigned to either the general anesthesia group (GA group) or the general anesthesia combined with paravertebral block group (TPVB group). Postoperative pain was assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) scale at 2, 4, 8, 12, and 24 h after surgery. The primary outcome was the pain intensity, and secondary outcomes included pain scores at rest and during activity, postoperative opioid consumption, adverse events, and recovery quality. RESULTS: Of the 120 patients enrolled and randomized, 110 completed the study (GA group, n = 54; TPVB group, n = 56).Results showed that the TPVB group had significantly lower pain intensity compared to the general anesthesia group (1.8 ± 0.3 vs. 2.2 ± 0.3, p < 0.001). Pain scores at rest and during activity were significantly reduced at 2, 4, and 8 h, and pain scores at rest remained significantly lower at 12 h. Compared with the GA group, the TPVB group had lower postoperative opioid consumption (0.2 [0.1–0.3] µg/kg vs. 0.3 [0.2–0.4] µg/kg, p = 0.024), a lower incidence of desaturation in the post‑anesthesia care unit (PACU) (2 [3.6%] vs. 12 [22.2%], p = 0.003), shorter PACU stay (21 [15–27] min vs. 31 [25–35] min, p < 0.001), earlier chest tube removal (3 [3–4] days vs. 4 [3–4] days, p = 0.013), and a shorter hospital stay (5 [4–6] days vs. 6 [5–7] days, p < 0.001). There were no significant differences in adverse events between the two groups. CONCLUSION: Unilateral TPVB for pediatric mediastinal tumor resection significantly reduces overall pain intensity within 24 h and pain scores within the first 8 h postoperatively, decreases opioid consumption during the first 24 h, and improves postoperative recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400083377, registered 23 April 2024.