Comparison of the Results of Ultrasound-Guided Thoracic Paravertebral Block and Modified Pectoral Nerve Block for Postoperative Analgesia in Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Study.

Abstract Objective(s) Video-assisted thoracoscopic surgery (VATS) has started to be used frequently due to its advantages during and after surgery. Thoracic paravertebral block (TPVB), facilitated by ultrasonography, is one of the blocks included in the multimodal analgesia recommended for this surgery. Modified pectoral nerve block (PECS II) is a technique developed for postoperative analgesia in breast surgery. In this study, the purpose is the comparison of ultrasound-guided PECS II block and TPVB in term of their the efficacy and safety for postoperative analgesia following VATS. Design A prospective, randomized controlled study. Setting Single institution, education and research hospital. Participants 52 patients (ASA I-III) between the ages of 18 and 65, who were to undergo VATS were randomized and divided into two groups. Interventions Thoracic paravertebral block was administered from two consecutive levels for TPVB group and a modified pectoral nerve block was performed in the PECS group. A patient-controlled analgesia device was used for intravenous morphine infusion to provide postoperative analgesia. Measurements and main results Postoperative morphine consumption and visual analog scale values were recorded 1, 2, 4, 8, 12, 24 h after surgery. There was no statistically significant difference between the 24-hour follow-up groups in terms of postoperative morphine consumption (p=0,073) and duration of analgesia (p=0.489). The two groups showed similar total remifentanil consumption, postoperative pain scores and the use of additional analgesia. Block related complications were not observed in both groups. Conclusions The analgesic efficacy of modified pectoral nerve block, which is more superficial and less at risk of complications, is similar to TPVB and may be involved in multimodal analgesia in pain control after VATS.