Comparison of paravertebral block techniques for postoperative analgesia after video-assisted thoracoscopic surgery for lung cancer: a retrospective cohort study.

PURPOSE: The purpose of this study was to compare the postoperative analgesic outcomes of ultrasound-guided single-shot, ultrasound-guided continuous, or surgeon-performed direct-vision single-shot approaches to paravertebral block (PVB).

METHODS: We retrospectively analyzed the data of the adults who underwent video-assisted thoracoscopic surgery (VATS) for lung resection at a university hospital. They were categorized into those who underwent ultrasound-guided single-shot PVB (PVB-US), ultrasound-guided continuous PVB with catheter infusion (PVB-US-Cath), and surgeon-performed intraoperative single-shot PVB under thoracoscopic visualization (PVB-VATS). The primary outcome was the number of rescue analgesic administrations within 24 h of admission to the post-anesthesia care unit (PACU). The secondary outcomes were rescue analgesic use within 24-48 h and pain scores at PACU admission and on the mornings of postoperative days (PODs) 1 and 2.

RESULTS: Of the 489 eligible patients, the data of 385 were included in the final analysis (PVB-US, n = 53; PVB-US-Cath, n = 249; PVB-VATS, n = 83). The median (IQR) numbers of rescue analgesic doses within 24 h for the PVB-US, PVB-US-Cath, and PVB-VATS groups were 1 (1-3), 2 (1-3), and 2 (0-3), respectively (p = 0.6880). Rescue analgesic use during 24-48 h and NRS pain scores at the PACU and on PODs 1 and 2 did not significantly differ between the groups.

CONCLUSION: This study found no statistically significant differences in the postoperative analgesic outcomes of the ultrasound-guided single-shot, ultrasound-guided continuous, and surgeon-performed direct-vision single-shot PVB techniques for VATS. Given the predominantly mild and short-lived nature of pain after VATS, a technically simple single-shot strategy may offer an optimal balance between efficacy, feasibility, and procedural efficiency.