Application and advantages of intrathoracic paravertebral block in uniportal video-assisted thoracoscopic surgery

Introduction Uniportal video-assisted thoracoscopic surgery (VATS) is widely used as a minimally invasive approach for pulmonary diseases. Although this technique reduces postoperative pain, acute postoperative pain remains clinically significant. This study aimed to evaluate the feasibility and advantages of thoracoscopic paravertebral block. Methods This single-center prospective randomized comparative study included 228 consecutive patients who underwent uniportal VATS at our institution between August 2022 and June 2024. Patients were randomly assigned to Group A (122 patients; intraoperative thoracoscopic direct-vision transthoracic paravertebral block) or Group B (106 patients; preoperative ultrasound-guided thoracic paravertebral block). Perioperative data, postoperative pain scores, opioid rescue analgesic use, and postoperative complications were analyzed. Repeated-measures analysis of variance was used to assess differences in postoperative pain scores over time between the two groups. Results A total of 228 patients underwent uniportal VATS pulmonary resection. No significant differences were observed between the two groups in terms of age, sex, pulmonary function, arterial blood gas analysis, surgical side, incision location, nodule size, nodule position, operative time, blood loss, drainage duration, length of hospital stay, tumor stage, or postoperative complications ( P > 0.05). Postoperative complications were less frequent in Group A than in Group B. No intraoperative or 30-day postoperative mortality occurred in either group. Repeated-measures ANOVA showed significant effects of group (F = 774.002, P < 0.001), time (F = 520.972, P < 0.001), and group×time interaction (F = 4.983, P = 0.001) on VAS scores. Conclusions These findings indicate that thoracoscopic paravertebral block is safe and effective. Compared with ultrasound-guided approaches, it was associated with lower postoperative pain scores and reduced rescue tramadol requirements. Further validation through prospective randomized controlled trials is required.