Postoperative Pain Management After Video-Assisted Thoracoscopic Surgery (VATS)

Regional Analgesia Recommendations

The American Society of Anesthesiologists recommends paravertebral block as a first-line regional technique for VATS due to its efficacy in reducing postoperative pain and opioid requirements 1, 2
Erector spinae plane block is equally recommended as a first-choice option, providing effective analgesia with potentially fewer complications than thoracic epidural 1, 3
Serratus anterior plane block can be used as an alternative when the first-choice blocks are contraindicated or technically difficult 1, 4

The American Pain Society recommends paracetamol be administered pre-operatively or intra-operatively and continued at regular intervals postoperatively 1, 2
NSAIDs or COX-2 inhibitors should be initiated pre-operatively or intra-operatively and continued postoperatively unless contraindicated (renal impairment, heart failure, bleeding risk) 2, 5
Intravenous dexmedetomidine is recommended intraoperatively when basic analgesics cannot be administered, providing analgesic and opioid-sparing effects 1, 3

Opioids should be used only as rescue analgesics for breakthrough pain, not as primary analgesics 1, 2
For immediate post-procedure breakthrough pain, intravenous fentanyl in divided doses is preferred 5

VATS, while less painful than thoracotomy, is still associated with significant acute and chronic postoperative pain that can negatively affect recovery 6, 1
The multimodal approach should be tailored based on patient comorbidities, particularly avoiding high-dose NSAIDs in patients with renal impairment or bleeding risk 5