Abstract Rationale Video-assisted thoracoscopic surgery (VATS) is associated with less postoperative pain than open thoracotomy; however, inadequate early analgesia can still impair respiratory recovery and prolong hospitalization. Regional anesthesia techniques, including erector spinae plane (ESP), paravertebral, serratus anterior plane, and intercostal nerve blocks, have emerged as effective alternatives to thoracic epidural analgesia. Recent studies have shown that intercostal and ESP blocks can enhance early recovery and reduce opioid consumption after thoracoscopic procedures (1,2). This study aimed to assess the association between the use and type of regional block and postoperative pain intensity 12 hours after thoracoscopic surgery in a tertiary care hospital. Methods A retrospective cohort study was conducted including 231 adult patients who underwent VATS between 2022 and 2024. Data collected included regional block use, block type (erector spinae, paravertebral, serratus anterior plane, intercostal), and visual analog scale (VAS) pain score at 12 hours postoperatively. Pain was categorized as absent (VAS = 0), mild (VAS 1-3), or moderate-to-severe (VAS 4). Differences in pain distribution were analyzed using the chi-square or Fisher’s exact test, with statistical significance defined as p 0.05. Results Among 231 patients, 22 (9.5%) received a regional block, mainly erector spinae plane (59.1%) and intercostal nerve blocks (40.9%). In patients with a regional block, 59.1% reported absent pain (VAS = 0), 33.2% mild pain (VAS 1-3), and 7.7% moderate-to-severe pain (VAS 4). In comparison, patients without a regional block reported 54.3%, 30.5%, and 15.2% in each category. Although differences were not statistically significant (p = 0.74), the trend toward fewer cases of moderate-to-severe pain among those receiving a regional block suggests a potential clinical benefit consistent with previous findings (1,2). Conclusion Regional anesthesia was used in fewer than 10% of thoracoscopic cases, primarily via erector spinae and intercostal nerve blocks. Although no statistically significant difference in pain intensity at 12 hours was identified, patients receiving regional blocks demonstrated a clinically relevant trend toward lower moderate-to-severe pain rates. Overall, postoperative pain control was satisfactory, reflecting effective multimodal analgesia. Larger prospective studies are warranted to confirm these findings and clarify the comparative efficacy of regional techniques in minimally invasive thoracic surgery. References: 1.Chen S, Guo Z, Wei X, et al. Efficacy of preemptive intercostal nerve block on recovery in patients undergoing video-assisted thoracic surgery. J Thorac Dis. 2023;15(4):1221-1230. 2.Largo-Pineda CE. Erector spinae plane block: a narrative review. Rev Colomb Anestesiol. 2022;50(4):291-300. This abstract is funded by: none
Montoya et al. (Fri,) studied this question.