Paravertebral Block and Perioperative Ketamine in an Opioid-Sparing Analgesia Approach in Video-Assisted Thoracic Surgery: A Retrospective Single-Centre Study

Abstract

Background: Regional anaesthesia techniques allow postoperative pain control while reducing opioid consumption. Ketamine is another viable option for minimising perioperative opioid use. We evaluated the efficacy of a perioperative multimodal analgesia protocol incorporating paravertebral block (PVB) and ketamine infusion in patients undergoing video-assisted thoracic surgery (VATS). Methods: This retrospective single-centre study divided patients into two groups: the opioid-sparing (OS) group receiving PVB and ketamine (n = 41), and the control group (n = 21) treated with postoperative morphine infusion. The primary outcome was the need for rescue opioid therapy; secondary outcomes included postoperative pain scores assessed at multiple time points over 48 h using the numeric rating scale (NRS), prevalence of chronic postoperative pain at three months, perioperative haemodynamics, and hospital length of stay. Results: Rescue opioid administration was significantly lower in the OS group (19.5% vs. 47.6%, p = 0.021). Upon awakening, pain control was better in the OS group (1 [1-2] vs. 4 [3-4], p < 0.001); however, pain scores did not differ afterwards. Chronic postoperative pain was less common in the OS group (n = 10/41; 23.8% vs. n = 11/21, 52.4%; p = 0.028). No differences in haemodynamics were reported, nor were there any ketamine/PVB-related complications. No difference in length of hospital stay was observed between the groups. The ketamine starting dose and postoperative morphine requirements were inversely correlated (rho = -0.380; p = 0.002). Conclusions: A multimodal analgesia protocol integrating PVB and ketamine infusion in patients undergoing VATS may effectively reduce postoperative opioid consumption, improving analgesia in the initial postoperative period.

Keywords: chronic pain; locoregional anaesthesia; morphine consumption; video assisted thoracoscopy.

Figure 1

NRS. NRS after surgery was lower in OS group (1 [1–2]) compared to control group (4 [3–4]; p > 0.001).