Thoracoscopic-Guided versus Ultrasound-Guided Thoracic Paravertebral Nerve Block in Uniport Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial

Abstract Background Although effective, ultrasound-guided thoracic paravertebral block (USG-TPVB) is technically challenging and highly dependent on operator skill and equipment. Thoracoscopic-guided thoracic paravertebral block (TSG-TPVB) offers procedural simplicity and is being increasingly used as an alternative. This study compares the efficacy and safety of TSG-TPVB against USG-TPVB in patients undergoing uniport video-assisted thoracic surgery (uni-VATS). Methods Patients undergoing uni-VATS were randomly assigned to either the TSG-TPVB group (n = 41) or the USG-TPVB group (n = 40). The primary outcome was the patient's pain intensity, which was assessed using the visual analog scale (VAS) at different postoperative time points, with group differences evaluated against a noninferiority margin of 5 points (Δ). The duration of the TPVB procedure, TPVB-related complications and other indicators were also analyzed. Results TSG-TPVB was found to be noninferior to USG-TPVB in terms of patients’ resting and cough-evoked pain intensity throughout the postoperative period. Notably, compared with the USG-TPVB group, the TSG-TPVB group had a significantly shorter procedure duration (138.05 ± 34.96 vs. 219.25 ± 35.67 seconds, P < 0.001) and a lower incidence of complications (P = 0.001). No significant differences were found in the frequency of rescue analgesia, the number of PCA activations, or other related indicators. Conclusions TSG-TPVB demonstrated noninferior analgesic efficacy up to 72 hours postoperatively and was associated with fewer complications and greater operational efficiency. Its straightforward technique and short learning curve make it an easily adoptable option for routine clinical practice. Trial registration: This study was registered with the Chinese Clinical Trial Registry on August 2, 2021 (registration No. ChiCTR2100049416).