{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:14:01Z","timestamp":1788444841526,"version":"build-2803163510"},"reference-count":9,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Nanjing medical science and technology development key project","award":["ZKX21038"],"award-info":[{"award-number":["ZKX21038"]}]},{"name":"Scientific Research Project of the Talent Development Fund of Geriatric Hospital of Nanjing Medical University","award":["IR2024104"],"award-info":[{"award-number":["IR2024104"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Background<\/jats:title>\n Thoracic paravertebral block (TPVB) is widely used for analgesia in thoracoscopic lung resection, offering effective pain relief and enhanced recovery. However, preoperative TPVB may block both thoracic somatic nerves and cardiac sympathetic nerves, potentially increasing the risk of hypotension during general anaesthesia induction. This study aims to compare the haemodynamic effects of TPVB performed at the superficial vs deep layers of the superior costotransverse ligament (SCTL).<\/jats:p>\n <\/jats:sec>\n \n Methods and analysis<\/jats:title>\n This randomised controlled trial will enrol 128\u2009patients undergoing thoracoscopic lung resection under general anaesthesia. Patients will be randomised (1:1) to one of two groups: the Deep SCTL Block Group (Group T), receiving ultrasound-guided deep layer SCTL block 30\u2009min before surgery in the pre-anaesthesia room, or the Superficial SCTL Block Group (Group S), receiving ultrasound-guided superficial layer SCTL block at the same time point. In addition, a supplementary single-centre exploratory 3D-CT imaging substudy will enrol 40\u2009patients requiring clinically indicated preoperative CT-guided lesion localisation. These participants will be randomly allocated at a 1:1 ratio to receive either deep or superficial SCTL block before CT-guided localisation. 3D-CT imaging will be performed 30\u2009min after block administration to compare contrast-enhanced local anaesthetic spread patterns and explore their potential associations with peri-induction haemodynamic changes.<\/jats:p>\n The primary outcome is the incidence of hypotension during general anaesthesia induction. Secondary outcomes include the incidence of severe hypotension during induction, as well as Visual Analogue Scale scores at rest and during movement at 4 and 24 hours postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Ethics and dissemination<\/jats:title>\n This trial was approved by the Ethics Committee of Nanjing First Hospital (No. KY20240924-03-KS-01) on 24 September 2024. The results will be peer-reviewed for publication in a scientific journal.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT06841822<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115332","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T03:24:01Z","timestamp":1785122641000},"page":"e115332","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of ultrasound-guided superficial versus deep superior costotransverse ligament on haemodynamics during general anaesthesia induction of thoracoscopic lung resection: protocol for a multicentre, double-blind, randomised controlled trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06841822","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06841822","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Yajie","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"},{"name":"Department of Anesthesiology, Nanjing Red Cross Hospital, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2637-6001","authenticated-orcid":false,"given":"Wenwen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaojing","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqi","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honggang","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoliang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026090306255480000_16.7.e115332.1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/ACO.0000000000001451","article-title":"Pros and cons of different blocks for postoperative analgesia after video-assisted thoracic surgery","volume":"38","author":"Karakaya","year":"2025","journal-title":"Curr Opin Anaesthesiol"},{"key":"2026090306255480000_16.7.e115332.2","doi-asserted-by":"crossref","first-page":"9507","DOI":"10.1097\/JS9.0000000000003135","article-title":"Clinical effects, mechanisms and spread of erector spinae plane block and paravertebral block in thoracic and breast surgery: a narrative review","volume":"111","author":"Zhang","year":"2025","journal-title":"Int J Surg"},{"key":"2026090306255480000_16.7.e115332.3","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2021-102588"},{"key":"2026090306255480000_16.7.e115332.4","doi-asserted-by":"crossref","unstructured":"Piraccini E , Byrne H , Taddei S . Superior costotransverse ligament: a new target for fascial plane blocks. Reg Anesth Pain Med 2020. doi:10.1136\/rapm-2020-101315","DOI":"10.1136\/rapm-2020-101315"},{"key":"2026090306255480000_16.7.e115332.5","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1111\/anae.13527","article-title":"Does paravertebral block require access to the paravertebral space?","volume":"71","author":"Costache","year":"2016","journal-title":"Anaesthesia"},{"key":"2026090306255480000_16.7.e115332.6","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.bja.2022.06.034","article-title":"Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-centre cohort study","volume":"129","author":"Wesselink","year":"2022","journal-title":"Br J Anaesth"},{"key":"2026090306255480000_16.7.e115332.7","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1111\/anae.14416","article-title":"The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis","volume":"73","author":"Maheshwari","year":"2018","journal-title":"Anaesthesia"},{"key":"2026090306255480000_16.7.e115332.8","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005250"},{"key":"2026090306255480000_16.7.e115332.9","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/ALN.0000000000003610","article-title":"Perioperative Blood Pressure Management","volume":"134","author":"Saugel","year":"2021","journal-title":"Anesthesiology"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-115332","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:26:53Z","timestamp":1788442013000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-115332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":9,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2025-115332"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-115332","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}