ObjectiveTo explore the safety and efficacy of thoracoscopy-guided thoracic paravertebral block (TPVB) in thoracoscopic pulmonary resection, and to provide strategies for enhanced recovery after surgery (ERAS) in thoracoscopic lung resection. MethodsPatients who underwent thoracoscopic pulmonary resection (including sublobar resection and lobectomy) in the 987th Hospital of Joint Logistics Support Force of People's Liberation Army, General Hospital of Central Theater Command of the People’s Liberation Army, and the First Affiliated Hospital with Nanjing Medical University between May 2021 and June 2023 were prospectively enrolled. The patients were randomly allocated into three groups in a single-blind manner using a random number table. Group A (incisional nerve block group) received a subcutaneous injection of ropivacaine (0.375%, 2 mg/kg) around the incision during chest closure. Group B (ultrasound-guided TPVB group) received an ultrasound-guided injection of ropivacaine (0.375%, 2 mg/kg) at the paravertebral space after chest closure. Group C (thoracoscopy-guided TPVB group) received a thoracoscopy-guided intrathoracic injection of ropivacaine (0.375%, 2 mg/kg) at the paravertebral space during chest closure. Perioperative adverse drug reactions, pain scores, postoperative analgesic consumption, and postoperative length of hospital stay were compared among the three groups. ResultsA total of 180 patients were included, comprising 108 females and 72 males, with a mean age of (62.15±7.36) years. There were no statistical differences among the three groups in baseline characteristics, including age, weight, gender, prevalence of comorbidities, operative time, number of surgical incisions, number of chest tubes, or intraoperative dosages of sufentanil and propofol (P>0.05). No adverse anesthesia events occurred during surgery in any of the groups. The pressing frequency of the patient-controlled intravenous analgesia (PCIA) pump, Visual Analogue Scale (VAS) pain scores, the rate of postoperative rescue analgesic use, and the incidences of postoperative cough and dizziness in the group C were significantly lower than those in the other two groups (P<0.05). The postoperative length of hospital stay in the group B and group C was significantly shorter than that in the group A (P<0.05). ConclusionThoracoscopy-guided TPVB during chest closure can effectively alleviate postoperative pain without increasing postoperative side effects, which facilitates the enhanced recovery after thoracoscopic lung surgery.
