J Cardiothorac Vasc Anesth. 2026 Aug 3:S1053-0770(26)00646-4. doi: 10.1053/j.jvca.2026.07.056. Online ahead of print.
ABSTRACT
OBJECTIVE: Thoracic paravertebral block (PVB) is an effective analgesic technique for video-assisted thoracoscopic surgery (VATS). The intertransverse process block (ITPB) may offer comparable analgesia with a better safety profile. The aim of this study is to compare the postoperative analgesic effects of ITPB and PVB in terms of morphine consumption and pain score.
DESIGN: A randomized, double-blind, non-inferiority trial.
SETTING: A university hospital.
PARTICIPANTS: This study enrolled 55 adult patients who underwent elective VATS, with 5 subsequently excluded.
INTERVENTIONS: Fifty patients were randomly allocated (1:1) to receive either an ultrasound-guided ITPB (n = 25) or a PVB (n = 25) at the T5-6 level. Both groups received a bolus of 20 mL 0.25% bupivacaine, followed by a continuous infusion of 10 mL/h for 48 hours.
MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was total morphine consumption in the first 48 postoperative hours. Secondary outcomes comprised postoperative visual analog scale (VAS) at rest and with deep breathing and block performance time. The 48-hour morphine consumption was similar between the ITPB and PVB groups (9.9 ± 2.8 mg v 8.9 ± 2.1 mg, respectively; mean difference 1.0 mg, 95% CI -0.39 to 2.45; p = 0.151). As the upper limit of this 95% confidence interval (2.45 mg) exceeded the prespecified non-inferiority margin of 1.0 mg, non-inferiority of ITPB to PVB was not statistically confirmed. VAS scores at rest and with deep breathing were comparable at all time points (p > 0.05 for all). The block performance time was shorter in the ITP group versus the PVB group (4.3 ± 0.8 v 6.9 ± 1.4 minutes; p < 0.001).
CONCLUSION: Continuous ITPB resulted in similar 48-hour morphine consumption, pain scores, and complication rates to continuous PVB for VATS, together with a shorter time to perform the block. However, the non-inferiority of ITPB to PVB was not statistically confirmed.
PMID:42637591 | DOI:10.1053/j.jvca.2026.07.056
