Efficacy and safety of regional anesthesia after thoracoscopic lobectomy

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OBJECTIVE

To determine the optimal pain relief regimen after thoracoscopic lobectomy.

MATERIAL AND METHODS

A prospective randomized study included 57 patients with lung cancer stage 1—2, ASA class I—IV who underwent thoracoscopic lobectomy with lymph node dissection. Patients were divided into three groups depending on pain relief method: 19 ones with prolonged paravertebral block, 19 patients with intraoperative intercostal block and 19 ones with systemic administration of analgesics and no regional anesthesia. Data on intensity of pain syndrome (VAS scores) at rest and coughing were collected within 72 hours after surgery. We considered stress hormones, FEV 1, arterial blood gases, dose of analgesics, complications, as well as VAS score and FEV 1 after removal of pleural tube.

RESULTS

Patients with paravertebral block had the lowest VAS scores compared to intraoperative intercostal block and no regional anesthesia (p=0.030 and p=0.039). Intraoperative intercostal block shows better pain relief in the first hours after surgery compared to the control group and paravertebral block (p=0.064). Patients with paravertebral block required fewer narcotic analgesics (p=0.014). Oxygenation index was higher in the group of paravertebral block compared to other groups (p=0.015). There were no complications in 60%, 51% and 40% of patients, respectively.

CONCLUSION

Prolonged paravertebral block ensures better quality of pain relief after thoracoscopic lobectomy, as well as fewer postoperative complications.

Keywords:

thoracoscopic lobectomy

paravertebral block

intercostal block

Authors:

Novikova O.V.

Institute for Leadership and Healthcare Management of the Sechenov First Moscow State Medical University

Volchkov V.A.

St. Petersburg State University;
St. Petersburg City Multi-field Hospital No. 2

ORCID: 0000-0002-5664-7386

Boyarkin A.A.

St. Petersburg State University;
St. Petersburg City Multi-field Hospital No. 2

ORCID: 0000-0002-5910-6200

Atyukov M.A.

St. Petersburg City Multidisciplinary Hospital No. 2

Received:

03.06.2022

Accepted:

23.06.2022

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