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

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

Makale detayları

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

Yazarlar:

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

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Anesteziyoloji

Dergi:

Anatolian Current Medical Journal Vol.7 Issue 5, pp.583-588

Belge Tipi:

Makale

Yayın Tarihi:

9/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001358268

pISSN:

2718-0115

Anahtar kelimeler:

Özet:

 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 n82 and peripheral block group PER, n65. 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 p0.001. PACU opioid administration and total MME consumption were also significantly reduced in the TEA group 0 mg IQR 02 vs. 2 mg IQR 04, p0.001. 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.

 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 n82 and peripheral block group PER, n65. 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 p0.001. PACU opioid administration and total MME consumption were also significantly reduced in the TEA group 0 mg IQR 02 vs. 2 mg IQR 04, p0.001. 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.

 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 n82 and peripheral block group PER, n65. 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 p0.001. PACU opioid administration and total MME consumption were also significantly reduced in the TEA group 0 mg IQR 02 vs. 2 mg IQR 04, p0.001. 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.

 GirişAmaç: 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 n82 ve periferik blok PER, n65. 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 p0.001. PACUda uygulanan opioid miktarı ve toplam MME tüketimi de TEA grubunda belirgin şekilde daha düşüktü 0 mg IQR 02 vs. 2 mg IQR 04, p0.001. 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.

Makale detayları

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

Yazarlar:

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

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Anesteziyoloji

Dergi:

Anatolian Current Medical Journal Vol.7 Issue 5, pp.583-588

Belge Tipi:

Makale

Yayın Tarihi:

9/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001358268

pISSN:

2718-0115

Thoracic epidural analgesia

video-assisted thoracoscopic surgery

paravertebral block

erector spinae plane block

serratus anterior plane block

postoperative painTorakal epidural analjezi

video yardımlı torakoskopik cerrahi

paravertebral blok

erector spinae plan blok

serratus anterior plan blok

postoperatif ağrı

Sayı

Makale detayları

Yazarlar: Ergun Mendes | Doruk Yaylak | Yasemin Sincer | Mete Manici | Yavuz Gürkan

Yayıncı: MediHealth Academy Yayıncılık

Ana Başlıklar: Anesteziyoloji

Dergi: Anatolian Current Medical Journal Vol.7 Issue 5, pp.583-588

Belge Tipi: Makale

Yayın Tarihi: 9/2025

Belge Dili: İngilizce

Document ID (Org No.): 2001358268

pISSN: 2718-0115

Sayı

Yazarlar:

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

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Anesteziyoloji

Dergi:

Anatolian Current Medical Journal Vol.7 Issue 5, pp.583-588

Belge Tipi:

Makale

Yayın Tarihi:

9/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001358268

pISSN:

2718-0115