Efficacy and safety of Thoracoscopic-guided Paravertebral Block on the Early Postoperative Analgesia following Video-assisted Thoracoscopic Lobectomy: A Randomized Blinded Controlled Study

Background: Paravertebral block (PVB) has been increasingly popular for postoperative analgesia. However, a well-designed randomized study is needed to estimate the efficacy and safety of PVB using thoracoscope-assisted technique for early postoperative analgesia following video-assisted thoracoscopic lobectomy (VATS LOBECTOMY). Methods: 106 patients scheduled for elective VATS LOBECTOMY were randomly assigned into two groups in a 1:1 ratio. Control group: receiving patient-controlled intravenous analgesia (PCIA) after surgery; PVB group: receiving thoracoscopic-guided multi-points PVB before the end of the surgery combined with PCIA following surgery. The primary endpoint was opioid consumption within 48 h after surgery. Results: Compared with control group, sufentanil consumption was significantly lower in PVB group with longer duration of first time PCIA usage, less times of analgesic pump pressing and less rescue analgetic consumption. VAS scores at rest and during exercising were significantly lower in PVB group at all time points within the first 48h after surgery. PVB group was also associated with significantly higher total QoR-40 scores and lower incidence of analgesia related adverse events. Conclusions: Thoracoscopic-guided PVB were effective and safe for early postoperative analgesia after VATS LOBECTOMY. Additionally, thoracoscope-assisted modality is technically easy, it should be recommended before the end of VATS LOBECTOMY.