{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:27Z","timestamp":1788502347284,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Ultrasound-guided intercostal nerve block (ICNB) is an effective modality for alleviating pain after video-assisted thoracic surgery (VATS). However, the optimal timing for its administration remains controversial. This study aimed to compare the analgesic efficacy of preoperative versus postoperative ICNB in patients undergoing VATS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 172 adult patients undergoing VATS were randomized into two parallel groups: the pre-ICNB group (preoperative ultrasound-guided ICNB,\n                      <jats:italic>n<\/jats:italic>\n                      = 88) and the post-ICNB group (postoperative ultrasound-guided ICNB,\n                      <jats:italic>n<\/jats:italic>\n                      = 84). The primary outcome was the incidence of at least one episode of moderate-to-severe pain at rest (Numeric Rating Scale [NRS] score &amp;gt; 4) during the first 24 h postoperatively. Secondary outcomes included NRS scores during coughing, perioperative opioid consumption, sleep quality, and the incidence of postoperative complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The incidence of moderate-to-severe resting pain during the first 24 h postoperatively was significantly lower in the post-ICNB group than in the pre-ICNB group (11.9% vs. 28.4%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Both static (at rest) and dynamic (during coughing) NRS scores were significantly lower in the post-ICNB group at 4, 6 and 8 h postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05); however, comparable pain scores were observed upon admission to the post-anesthesia care unit (PACU) and at 2, 24, and 48 h postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;gt; 0.05). Cumulative postoperative opioid consumption at 24 and 48 h was significantly lower in the post-ICNB group (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). Furthermore, patients in the post-ICNB group exhibited superior sleep quality during the first two postoperative nights (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). No significant differences were observed in total (intraoperative + postoperative) opioid consumption, overall recovery quality, or surgical\/anesthetic complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative ICNB provides superior early postoperative analgesia, reduces postoperative opioid requirements, and improves sleep quality compared with preoperative ICNB. These findings suggest that postoperative administration is a more effective strategy for acute pain management following VATS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/showproj.aspx?proj=183278<\/jats:ext-link>\n                      , identifier ChiCTR2300079183.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1825123","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:28:43Z","timestamp":1788499723000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative and postoperative ultrasound guided intercostal nerve blockade on postoperative analgesia in patients undergoing video assisted thoracic surgery (VATS): a prospective randomized comparative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Nan","family":"Xie","sequence":"first","affiliation":[{"name":"Fudan University Shanghai Cancer Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Luo","sequence":"additional","affiliation":[{"name":"Fudan University Eye Ear Nose and Throat Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Zhu","sequence":"additional","affiliation":[{"name":"Fudan University Shanghai Cancer Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Fudan University Shanghai Cancer Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Fudan University Shanghai Cancer Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.jtcvs.2009.03.030","article-title":"Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer.","volume":"138","author":"Flores","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1093\/ejcts\/ezt525","article-title":"Regional analgesia for video-assisted thoracic surgery: a systematic review.","volume":"45","author":"Steinthorsdottir","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.21037\/tlcr.2019.12.25","article-title":"Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery.","volume":"8","author":"Gao","year":"2019","journal-title":"Transl Lung Cancer Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/anae.15609","article-title":"PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations.","volume":"77","author":"Feray","year":"2022","journal-title":"Anaesthesia"},{"key":"B5","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s44254-025-00124-3","article-title":"Efficacy of paravertebral transcutaneous electrical nerve stimulation in perioperative analgesia and enhanced recovery after thoracoscopic lobectomy: a randomized, sham-controlled clinical trial.","volume":"3","author":"Chu","year":"2025","journal-title":"Anesthesiol Perioper Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jclinane.2019.07.002","article-title":"The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial.","volume":"59","author":"Chen","year":"2020","journal-title":"J Clin Anesth"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1053\/j.jvca.2020.09.102","article-title":"Are thoracic wall blocks efficient after video-assisted thoracoscopy surgery-lobectomy pain? 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