Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

Background: Ultrasound-guided serratus anterior plane block (USG-SAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting the adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of different concentrations of dexmedetomidine and ropivacaine in USG-SAPB for patients undergoing MRM.Patients and methods: Ninety-five female patients were randomly allocated to RD1 and RD2 groups. USG-SAPB was performed before anesthesia induction. Consumption of sufentanil, postoperative pain scores, and level of sedation were recorded 1–72 h postoperatively. Intraoperative hemodynamics, PACU length of stay, incidence of moderate-severe pain, one-time puncture success, block procedure time, time to first rescue analgesia, satisfaction scores of patients and surgeons, hospital length of stay, adverse events, the prevalence of chronic pain, and quality of postoperative functional recovery were recorded.Results: Dynamic VAS was significantly lower at 4, 8, and 12 h after surgery and sufentanil need was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P<0.05). The incidence of moderate-severe pain was significantly lower in the RD2 group (P<0.05). Time to first rescue analgesia was significantly longer in the RD2 group (P=0.047). Consumption of propofol, remifentanil, dexmedetomidine, use of vasoactive agents, and PACU length of stay (LOS) were significantly reduced in RD2 patients (P<0.05). There were no significant differences between the two groups with respect to procedural variables or satisfaction scores of patients and surgeons, and/or postoperative complications. The hospital LOS, global QoR-40, and prevalence of chronic pain were comparable.Conclusions: Use of 1 μg/kg dexmedetomidine and ropivacaine in USG-SAPB can provide superior postoperative analgesia for patients undergoing MRM without additional adverse effects, and result in similar quality of postoperative functional recovery and prevalence of chronic pain.