BACKGROUND

Early recovery of external respiratory function and gavorable postoperative period are essential after VTS anatomical lung resections. High-quality pain relief is important in rehabilitation after surgery, but the effect of analgesia on postoperative complications is unclear.

OBJECTIVE

To determine the influence of regional analgesia methods in multimodal pain relief on complication rate after video-assisted thoracoscopic anatomical lung resection.

MATERIAL AND METHODS

A prospective randomized study included 84 patients who were randomized into 3 groups depending on postoperative pain relief: group 1 — 28 patients with prolonged paravertebral block (PVB), group 2 — 29 patients with intercostal block (ICB), group 3 — 27 patients without regional methods of pain relief. In all groups, systemic multimodal analgesia was carried out according to the same scheme using narcotic analgesics, NSAIDs and paracetamol.

RESULTS

VAS score in the first hours after surgery was significantly lower in groups 1 and 2, where regional methods were used (p>0.001). Subsequently, minimum values remained in the PVB group with significantly smaller amount of administered promedol (p=0.002). The number of postoperative complications was significantly lower in the PVB group — 28% (8/28) (34% (10/29) in the ICB group, 52% (14/27) in the regional anesthesia group) (p=0.047). The most common complications were prolonged air release, hyperexudation and pleuritis that increased duration of pleural drainage. However, pain management and morbidity did not have a significant effect on hospital-stay (p=0.255).

CONCLUSION

Extended PVB promotes more effective pain relief after VTS anatomical pulmonary resections that leads to fewer postoperative complications and reduces duration of pleural drainage.