Regional anaesthesia in Video or Robot assisted thoracic surgery: A French multicentre prospective observational cohort study (ARTIST study)

BACKGROUND: Minimally invasive thoracic surgery, including Video-Assisted Thoracic Surgery (VATS) and Robot-Assisted Thoracic Surgery (RATS), is associated with improved postoperative recovery compared to thoracotomy, particularly by reducing pain. The 2019 French guidelines recommend regional anaesthesia (RA) techniques for these procedures. The ARTIST study aimed to assess the prevalence of RA practices in thoracic surgery centres across France. METHODS: This study was a prospective, multicentre, observational study conducted across 23 French surgical centres. All consecutive patients aged ≥18 years scheduled for elective VATS/RATS were included. The primary objective was to determine the prevalence of RA use. Secondary objectives included describing anaesthesia management and assessing perioperative morbidity and mortality. Data were collected prospectively, and statistical analyses included univariate comparisons between RA techniques, with significance set at p < 0.05. RESULTS: From January 2021 to September 2022, 456 patients were enrolled. 413/456 (91%) received RA, including 56/413 (14%) thoracic epidural analgesia, 292/413 (71%) paravertebral blocks, 71/413 (17%) erector spinae plane blocks, 72/413 (17%) serratus anterior plane blocks, and 32/413 (8%) intercostal nerve blocks. No significant differences were observed between block types. In the RA group: 257/413(62%) patients received a single type of RA, while 102/413 (25%) patients received multiple RA techniques. CONCLUSIONS: RA is widely implemented in minimally invasive thoracic surgery, though significant variability exists in block selection and combination. Multiple-block strategies may provide benefits in postoperative recovery, but further studies are warranted to explore their optimal use and safety in VATS and RATS. REGISTRATION: ClinicalTrials.gov: NCT05126524.