Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS)

ABSTRACT

Objectives

Uniportal video-assisted thoracic surgery (VATS) has been successfully used worldwide as a minimally invasive method of thoracoscopic surgery. Although pain was significantly reduced after VATS, acute postoperative pain was still significant. This study aimed to assess the advantages and feasibility of intercostal nerve block in uniportal VATS.

Methods

We conducted a retrospective analysis of perioperative data from 280 consecutive patients who underwent uniportal VATS at our institution between May 2021 and February 2022. The patients were assigned to either Group A (142 patients with 3 intercostal nerves blocked) or Group B (138 patients with 5 intercostal nerves blocked). We analyzed the perioperative data of both groups and utilized repeated measures ANOVA to determine the difference in postoperative pain between the two groups across time.

Results

A total of 280 patients underwent successful uniportal VATS during the study period. There were no significant differences between Group A and Group B in terms of age, gender, pulmonary function, arterial blood gas analysis, laterality, incision location, nodule size, nodule location, operative time, blood loss, drainage time, length of hospital stays, tumor stage, or postoperative complications. Furthermore, no surgical or 30-day postoperative mortalities occurred. Using repeated measures ANOVA, we found that the intercostal nerve block had significant effects on the group, time, and interaction terms group × time (P < 0.05).

Conclusion

Intercostal nerve block is safe and effective, and is associated with simple, accurate, and high patient satisfaction as opposed to other postoperative analgesics in uniportal VATS. Blocking five intercostal nerves may be more beneficial for effective postoperative pain management. Nevertheless, further confirmation through prospective randomized controlled trials is required.

KEYWORDS:

• Intercostal nerve block
• uniportal video-assisted thoracic surgery
• visual analogue scale pain scores
• ropivacaine

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical statement

This study was approved by the Ethics Committee of the Shenyang Chest Hospital. Written consent from the patient families were obtained according to the Declaration of Helsinki (1964).

Author contributions

LL Wang drafted the manuscript. Data acquisition was performed by LL Wang. LL Wang and LH Ge designed the analysis. Y Ren and LL Wang conceived and designed the study. All authors have read and approved the final manuscript.

Additional information

Funding

This study was supported by The Natural Science Foundation of Liaoning Province (2022-MS-433).