Comparison of thoracic epidural and peripheral regional analgesia techniques for postoperative pain management in video-assisted thoracoscopic surgery (VATS) procedures: a retrospective study

Year 2025, Volume: 7 Issue: 5, 583 - 588, 15.09.2025

Ergun Mendes , Doruk Yaylak , Yasemin Sincer , Mete Manici , Yavuz Gürkan

https://doi.org/10.38053/acmj.1752156

https://izlik.org/JA59XC84CW

Abstract

Aims: Effective postoperative analgesia is essential in thoracic surgery to preserve respiratory function, facilitate early mobilization, and reduce pulmonary complications. Thoracic epidural analgesia (TEA) has traditionally been regarded as the gold standard for pain control. However, the increasing use of minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) has prompted the adoption of ultrasound-guided peripheral regional anesthesia techniques, including the paravertebral block (PVB), erector spinae plane block (ESPB), and serratus anterior plane block (SAPB). This study aimed to compare TEA and peripheral regional blocks in terms of postoperative pain scores, opioid consumption, and recovery parameters in patients undergoing VATS procedures.
Methods: This retrospective study included patients who underwent elective VATS between January 2023 and January 2025. Based on the analgesic technique received, patients were divided into two groups: TEA (n=82) and peripheral block group (PER, n=65). Pain was assessed using the Visual Analog Scale (VAS) at the post-anesthesia care unit (PACU) and at 24, 48, and 72 hours postoperatively. Opioid doses were standardized to morphine milligram equivalents (MME). Additional outcomes included intraoperative opioid use, postoperative rescue analgesia, length of hospital stay (LOS), complication rates, and 90-day mortality.
Results: Patients in the TEA group had significantly lower VAS scores at all time points compared to the PER group (p<0.001). PACU opioid administration and total MME consumption were also significantly reduced in the TEA group (0 mg [IQR 0–2] vs. 2 mg [IQR 0–4], p<0.001). Although intraoperative opioid use was generally similar, TEA provided greater opioid-sparing effects. No significant differences were observed between groups in LOS, complication rates, or 90-day mortality.
Conclusion: TEA demonstrated superior efficacy in postoperative pain control and opioid reduction compared to peripheral regional anesthesia techniques in patients undergoing VATS. While TEA remains the preferred option when feasible, ultrasound guided peripheral blocks offer a valuable alternative, particularly in patients with contraindications to neuraxial techniques.

Keywords

Thoracic epidural analgesia , video-assisted thoracoscopic surgery , paravertebral block , erector spinae plane block , serratus anterior plane block , postoperative pain

Video yardımlı torakoskopik cerrahi (VATS) girişimlerinde postoperatif ağrı yönetimi için torakal epidural ve periferik rejyonel analjezi tekniklerinin karşılaştırılması: tek merkezli retrospektif bir analiz

https://izlik.org/JA59XC84CW

Abstract

Giriş/Amaç: Toraks cerrahisinde etkili postoperatif analjezi, solunum fonksiyonlarının korunması, erken mobilizasyonun sağlanması ve pulmoner komplikasyonların azaltılması açısından kritik öneme sahiptir. Torakal epidural analjezi (TEA), geleneksel olarak ağrı kontrolünde “altın standart” olarak kabul edilmiştir. Ancak, video yardımlı torakoskopik cerrahi (VATS) gibi minimal invaziv yaklaşımların giderek daha yaygın hale gelmesi, ultrason eşliğinde uygulanan paravertebral blok (PVB), erector spinae plane blok (ESPB) ve serratus anterior plane blok (SAPB) gibi periferik rejyonel anestezi tekniklerinin kullanımını artırmıştır. Bu çalışma, VATS uygulanan hastalarda TEA ve periferik rejyonel blokların postoperatif ağrı skorları, opioid tüketimi ve iyileşme parametreleri açısından karşılaştırılmasını amaçlamaktadır.
Gereç ve Yöntem: Bu retrospektif kohort çalışmaya, Ocak 2023 ile Ocak 2025 tarihleri arasında elektif VATS geçiren hastalar dahil edilmiştir. Uygulanan analjezi tekniğine göre hastalar iki gruba ayrılmıştır: TEA (n=82) ve periferik blok (PER, n=65). Ağrı düzeyleri, anestezi sonrası bakım ünitesinde (PACU) ve postoperatif 24, 48 ve 72. saatlerde görsel analog skala (VAS) kullanılarak değerlendirilmiştir. Opioid dozları morfin miligram eşdeğeri (MME) olarak standartlaştırılmıştır. Ek olarak değerlendirilen sonuçlar arasında intraoperatif opioid kullanımı, postoperatif kurtarma analjezisi ihtiyacı, hastanede kalış süresi (LOS), komplikasyon oranları ve 90 günlük mortalite yer almıştır.
Bulgular: TEA grubundaki hastalar, tüm zaman noktalarında PER grubuna kıyasla anlamlı olarak daha düşük VAS skorlarına sahipti (p<0.001). PACU’da uygulanan opioid miktarı ve toplam MME tüketimi de TEA grubunda belirgin şekilde daha düşüktü (0 mg [IQR 0–2] vs. 2 mg [IQR 0–4], p<0.001). İntraoperatif opioid kullanımı genel olarak benzer olmakla birlikte, TEA daha belirgin bir opioid koruyucu etki sağlamıştır. LOS, komplikasyon oranları ve 90 günlük mortalite açısından gruplar arasında anlamlı bir fark saptanmamıştır.
Sonuç: TEA, VATS geçiren hastalarda postoperatif ağrı kontrolü ve opioid kullanımının azaltılması açısından periferik rejyonel anestezi tekniklerine kıyasla üstünlük göstermiştir. Uygulanabilir olduğu durumlarda TEA tercih edilmesi önerilirken, ultrason eşliğinde uygulanan periferik bloklar, özellikle santral bloklara kontrendikasyonu olan hastalarda değerli bir alternatif olarak öne çıkmaktadır.

Keywords

Torakal epidural analjezi , video yardımlı torakoskopik cerrahi , paravertebral blok , erector spinae plan blok , serratus anterior plan blok , postoperatif ağrı

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