Optimizing patient outcomes: the impact of multimodal preemptive analgesia in video-assisted thoracoscopic lobectomy

Abstract

Objectives: The aim of this study was to evaluate the efficacy of a multimodal preemptive analgesia management approach, specifically incorporating ultrasound-guided thoracic paravertebral block (UG-TPVB) in conjunction with intravenous analgesia, after video-assisted thoracoscopic (VATS) lobectomy under the guidance of enhanced recovery after surgery.

Methods: A total of 690 patients who underwent VATS lobectomy between October 2021 and March 2022 were divided into the UG-TPVB group (group T, n = 345) and the control group (group C, n = 345). Patients in group T received UG-TPVB prior to the induction of general anaesthesia, while group C did not undergo nerve block. A comparison was conducted between the 2 groups regarding various indicators, including postoperative sedation, static/dynamic numeric rating scale scores, intraoperative fentanyl consumption, duration of mechanical ventilation/anaesthesia recovery/hospitalization, postoperative complications and other relevant factors.

Results: The static/dynamic numeric rating scale scores of group T were lower than those of group C after surgery. Intraoperative fentanyl consumption in group T (0.384 ± 0.095 mg) was lower than that in group C (0.465 ± 0.053 mg). The duration of mechanical ventilation, anaesthesia recovery and hospitalization were significantly shorter in group T compared to group C. Patient satisfaction rate in group T (70.1%) was higher than that in group C (53.6%). All differences were statistically significant (P < 0.05).

Conclusions: The multimodal preemptive analgesia management strategy effectively reduces postoperative pain, decreases opioid consumption and promotes faster recovery in patients undergoing VATS lobectomy.

Keywords: Enhanced recovery after surgery; Intravenous analgesia; Ultrasound-guided thoracic paravertebral block; Video-assisted thoracoscopic lobectomy.

Graphical abstract

Figure 1:

Comparison of static/dynamic NRS scores (A and B, respectively) in group T and group C at 4, 12, 24 and 48 h post-surgery. Group C underwent general anaesthesia alone. In contrast, group T received both ultrasound-guided thoracic paravertebral nerve block and general anaesthesia. Data are expressed as median (P25, P75), **P < 0.01.

Figure 2:

Frequency distribution histograms of mechanical ventilation and anaesthesia recovery duration (A and B, respectively).