Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

Abstract

Introduction: Pain is still severe after single-port video-assisted thoracoscopic (SPVAT) lung wedge resection. We observed the effect of single-injection thoracic paravertebral block (TPB) via the intrathoracic approach for analgesia after SPVAT lung wedge resection.

Methods: Sixty patients undergoing SPVAT lung wedge resection were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the T4 level with a scalp needle before closing the chest. The patients in the observation group received 20 ml 0.375% ropivacaine at the T4 level, and the patients in the control group received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption and number of PCIA presses in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h after surgery. The incidence of adverse reactions after surgery were recorded.

Results: The sufentanil consumption in the observation group was significantly lower than that in the control group (34.2 ± 1.9 µg vs. 52.3 ± 2.3 µg; P < 0.001). The VAS score at 6, 12, and 24 h after surgery, the incidence of adverse reactions after surgery in the observation group were significantly lower than those in the control group (all P < 0.05). The number of PCIA presses in the observation group was significantly lower than that in the control group [0 (0-0) times vs. 3 (2-4) times, P < 0.001].

Conclusions: Single-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after SPVAT lung wedge resection, with fewer adverse reactions.

Trial registration: ChiCTR2000034726.

Keywords: Lung wedge resection; Postoperative analgesia; Single injection; Single-port video-assisted thoracoscopic surgery; Thoracic paravertebral block.

Fig. 1

TPB at T4 level via intrathoracic approach under thoracoscopic direct vision

Fig. 2

Horizontal plane of paravertebral space. The orange area represents paravertebral space and site of scalp needle puncture

Fig. 3

Flow diagram of study

Fig. 4

Sufentanil consumptions within the first 24 h after surgery of the observation group and control group. *P < 0.001

Fig. 5

Dermatomes of the sensory block in the patient of observation group. Frequency of sensory segments blockade to sharp touch at 2 h later after surgery