Randomized Prospective Study Evaluating Single-Injection Paravertebral Block, Paravertebral Catheter, and Thoracic Epidural Catheter For Postoperative Regional Analgesia Following Video-Assisted Thoracoscopic Surgery

Abstract Objective Video-assisted thoracoscopic surgery (VATS) has improved patient outcomes; however, postoperative pain remains potentially severe. The objective of this study was to compare adjunct analgesic modalities for VATS, including paravertebral nerve blockade (PVB) and thoracic epidural anesthesia (TEA). Design Prospective, randomized trial Setting Large academic hospital, single institution Participants Adult patients undergoing VATS Interventions Ultrasound (US)-guided PVB catheter, US-guided single-injection PVB, or TEA. Measurements and Main Results Postoperative visual analog scale pain scores (at rest and with knee flexion) and opioid usage were recorded. Pain scores (with movement) for the TEA group were lower than those for either PVB group at 24 h (P ≤ .008) and for the PVB catheter group at 48 h (P = .002). Opioid use in TEA group was lower than that for either PVB group at 24 and 48 h (P Conclusions TEA led to lower pain scores and opioid requirement for VATS procedures compared with PVB techniques. Single-injection PVB was faster and equally as effective as PVB catheter, and it led to similar patient satisfaction as TEA; therefore, it should be considered in patients who are not ideal candidates for TEA.