Preemptive ultrasound-guided paravertebral block and immediate postoperative lung function

Background and objectives The aim of this study was to investigate the effects of preemptive ultrasound-guided thoracic paravertebral block versus intercostal block on postoperative respiratory function and pain control in patients undergoing video-assisted thoracoscopic surgery. Subjects 50 consecutive patients undergoing video-assisted thoracoscopic surgery. Method A prospective cohort of patients who received either ultrasound-guided thoracic paravertebral block immediately before the procedure or intercostal block placed by the surgeon at the end of the procedure were studied. Pulmonary function was assessed before surgery and 4 h postoperatively. Pain was assessed with the visual analog scale at 2 and 4 h after surgery both at rest and on coughing. Results 30 patients on the paravertebral block group and 20 on the intercostal block group were studied. Forced vital capacity ( p < 0.001), forced expiratory volume at 1 s ( p < 0.001) and forced expiratory flow 25–75 % ( p = 0.001) were significantly higher at 4 h with paravertebral block compared to the intercostal block group. The visual analog score for pain was significantly improved with paravertebral block at rest ( p < 0.05) and with cough ( p = 0.00). Perioperative narcotic use was significantly reduced with paravertebral block in comparison to intercostal block ( p = 0.04). Conclusions When compared to intercostal blocks, ultrasound-guided thoracic paravertebral block appears to preserve lung function and provide better pain control in the immediate postoperative period after video-assisted thoracoscopic surgery.