Effect of Early Versus Late Surgical Intercostal Block on Postoperative Pain Relief Following Video-Assisted Thoracic Surgery (VATS)

Effect of Early Versus Late Surgical Intercostal Block on Postoperative Pain Relief Following Video-Assisted Thoracic Surgery (VATS): a Randomised, Double-blind Study

Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain despite lower morbidity compared with thoracotomy. Adequate pain management is essential within Enhanced Recovery After Surgery (ERAS) pathways to preserve respiratory function and facilitate postoperative recovery. Surgical intercostal block performed under direct vision is a simple and effective regional analgesic technique commonly used following VATS. However, the optimal timing of intercostal block administration during surgery remains uncertain.

This prospective randomized double-blind study will compare surgical intercostal block performed at the beginning versus the end of the surgical procedure. The study aims to evaluate the effect of block timing on postoperative pain intensity and postoperative opioid consumption. The results may help optimize multimodal analgesic strategies in patients undergoing thoracic surgery.

Inclusion Criteria:

• Age ≥ 18 years
• Scheduled for single-port or two-port video-assisted thoracoscopic surgery (VATS).
• ASA classification 1 to 3
• Able to understand the study, describe their pain and provide valid informed consent

Exclusion Criteria:

• Neurological or psychiatric conditions that compromise the reliable assessment of pain(dementia, cognitive impairment, severe communication disorders)
• Chronic opioid use or regular use (> 3 months) of strong analgesics for chronic pain
• History of allergy or known hypersensitivity to local anaesthetics
• Coagulopathy or anticoagulant therapy precluding the safe performance of an intercostal block
• Local infection at the injection site or active systemic infection
• Bilateral thoracic surgery or intraoperative conversion to thoracotomy
• Second surgery at the same site.
• Current pregnancy or breastfeeding
• Inability to understand postoperative instructions or a language barrier preventing a validated assessment of pain
• Simultaneous participation in another clinical trial involving analgesia or thoracic surgery
• Refusal to participate or withdrawal of consent at any time