{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:42:52Z","timestamp":1763534572353,"version":"3.45.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"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. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medical thoracoscopy (MT) is increasingly performed under local anesthesia with sedation, yet suboptimal analgesia and discomfort remain common and may compromise patient safety, cooperation, and recovery. Ultrasound-guided thoracic paravertebral block (TPVB) provides targeted, long-lasting analgesia, while dexmedetomidine offers cooperative sedation with minimal respiratory depression. Evidence for their combined use in MT is limited. This study evaluated the perioperative efficacy and safety of TPVB plus dexmedetomidine compared with conventional local anesthesia and sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, randomized, controlled single-center trial, 83 patients undergoing elective MT were allocated to receive either TPVB plus intravenous dexmedetomidine sedation (Nerve Block group, n = 41) or standard local infiltration with conventional sedation (Control group, n = 42). Primary endpoints were intra- and postoperative pain scores (Visual Analog Scale [VAS], Behavioral Pain Scale [BPS]) and sedation depth (Bispectral Index [BIS]). Secondary endpoints included Quality of Recovery-15 (QoR-15) score at 24\u00a0h, intraoperative physiological stability, drug consumption, adverse events, and other recovery indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline characteristics were comparable between groups. TPVB plus dexmedetomidine provided significantly lower intraoperative VAS and BPS scores across all major procedural stages (all P &amp;lt; 0.05) and reduced postoperative VAS at 1\u00a0h, 6\u00a0h, and 24\u00a0h (all P &amp;lt; 0.05) without rebound pain. BIS values remained within the target range in both groups, with no differences (P &amp;gt; 0.05). The Nerve Block group achieved markedly higher QoR-15 scores at 24\u00a0h (median [IQR] 136.0 [124.0\u2013137.5] vs. 127.0 [124.0\u2013129.5]; P &amp;lt; 0.001), exceeding the minimal clinically important difference. Intraoperative hemodynamics, oxygenation, sedative and analgesic drug requirements, and the incidence of hypotension, bradycardia, hypoxemia, or movement were similar between groups, with no major cardiopulmonary or block-related complications. Other recovery outcomes (time to ambulation, gastrointestinal recovery, length of stay, PONV incidence) were comparable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients undergoing MT, ultrasound-guided TPVB combined with dexmedetomidine sedation significantly improved perioperative analgesia and early postoperative quality of recovery without increasing adverse events. This multimodal approach offers a safe, patient-centered anesthetic strategy aligned with enhanced recovery principles and may represent a preferred regimen for MT and other minimally invasive pleural interventions.<\/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\/<\/jats:ext-link>\n                      , identifier ChiCTR2500098034.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2025.1684199","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:38:32Z","timestamp":1763534312000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-guided thoracic paravertebral block combined with dexmedetomidine improves perioperative analgesia and recovery in medical thoracoscopy: a randomized controlled trial"],"prefix":"10.3389","volume":"16","author":[{"given":"Jia","family":"Nie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huanhuan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Fang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhimin","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai-Ying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.ccm.2021.08.010","article-title":"Medical thoracoscopy","volume":"42","author":"Avasarala","year":"2021","journal-title":"Clin. Chest Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"CD005179","DOI":"10.1002\/14651858.CD005179.pub4","article-title":"Psychological interventions for needle-related procedural pain and distress in children and adolescents","volume":"10","author":"Birnie","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1097\/MCP.0b013e32832b8b2d","article-title":"Medical thoracoscopy","volume":"15","author":"Casal","year":"2009","journal-title":"Curr. Opin. Pulm. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1053\/j.jvca.2017.10.003","article-title":"Paravertebral block for thoracic surgery","volume":"32","author":"D'ercole","year":"2018","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.23736\/S0375-9393.23.17291-9","article-title":"Pain management after thoracic surgery or chest trauma","volume":"89","author":"Feray","year":"2023","journal-title":"Minerva Anestesiol."},{"key":"B6","first-page":"157","article-title":"Comparison of two protocols of conscious analgosedation in video-assisted talc pleurodesis","volume":"71","author":"Gravino","year":"2005","journal-title":"Minerva Anestesiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.21037\/jtd-21-1740","article-title":"Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review","volume":"14","author":"Hamilton","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1111\/aas.14018","article-title":"Ultrasound-guided multiple-injection costotransverse block for mastectomy and primary reconstructive surgery. A study protocol","volume":"66","author":"Holm","year":"2022","journal-title":"Acta Anaesthesiol. Scand."},{"key":"B9","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.jclinane.2018.04.013","article-title":"Thoracic paravertebral block versus thoracic epidural analgesia for post-operative pain control in open pancreatic surgery: a randomized controlled trial","volume":"48","author":"Hutchins","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.2147\/CIA.S201323","article-title":"Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis","volume":"14","author":"Janssen","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"B11","doi-asserted-by":"publisher","first-page":"295","DOI":"10.3400\/avd.oa.16-00049","article-title":"Regional Anesthesia with dexmedetomidine infusion: a feasible method for the awake test during carotid endarterectomy","volume":"9","author":"Lee","year":"2016","journal-title":"Ann. Vasc. Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e14512","DOI":"10.1111\/ctr.14512","article-title":"Multimodal opioid-sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block","volume":"36","author":"Lewis","year":"2022","journal-title":"Clin. Transpl."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e137","DOI":"10.1016\/j.bja.2022.07.051","article-title":"Postoperative recovery with continuous erector spinae plane block or video-assisted paravertebral block after minimally invasive thoracic surgery: a prospective, randomised controlled trial","volume":"130","author":"Moorthy","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"B14","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/ALN.0000000000001158","article-title":"Minimal clinically important difference for three quality of recovery scales","volume":"125","author":"Myles","year":"2016","journal-title":"Anesthesiology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1177\/2050640616688140","article-title":"Dexmedetomidine vs propofol for gastrointestinal endoscopy: a meta-analysis","volume":"5","author":"Nishizawa","year":"2017","journal-title":"United Eur. Gastroenterol. J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1097\/ACO.0000000000000795","article-title":"Anesthesia for thoracic ambulatory surgery","volume":"32","author":"Raft","year":"2019","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"106840","DOI":"10.1016\/j.ijsu.2022.106840","article-title":"A comparison of regional anesthesia techniques in patients undergoing video-assisted thoracic surgery: a network meta-analysis","volume":"105","author":"Sandeep","year":"2022","journal-title":"Int. J. Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1093\/bja\/aeq265","article-title":"Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials","volume":"105","author":"Schnabel","year":"2010","journal-title":"Br. J. Anaesth."},{"key":"B19","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s13017-024-00559-2","article-title":"Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper","volume":"19","author":"Sermonesi","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1097\/ALN.0b013e318289b84b","article-title":"Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15","volume":"118","author":"Stark","year":"2013","journal-title":"Anesthesiology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.ijtb.2021.09.005","article-title":"Role of medical thoracoscopy in the diagnosis of pleural effusions","volume":"69","author":"Tousheed","year":"2022","journal-title":"Indian J. Tuberc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s40262-017-0507-7","article-title":"Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine","volume":"56","author":"Weerink","year":"2017","journal-title":"Clin. Pharmacokinet."},{"key":"B23","doi-asserted-by":"publisher","first-page":"580226","DOI":"10.3389\/fped.2020.580226","article-title":"Effects of dexmedetomidine on emergence agitation and recovery quality among children undergoing surgery under general anesthesia: a meta-analysis of randomized controlled trials","volume":"8","author":"Yang","year":"2020","journal-title":"Front. Pediatr."},{"key":"B24","doi-asserted-by":"publisher","first-page":"CD009121","DOI":"10.1002\/14651858.CD009121.pub2","article-title":"Paravertebral block versus thoracic epidural for patients undergoing thoracotomy","volume":"2","author":"Yeung","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"B25","doi-asserted-by":"publisher","first-page":"865362","DOI":"10.3389\/fsurg.2022.865362","article-title":"The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"9","author":"Zhao","year":"2022","journal-title":"Front. Surg."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1684199\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:38:33Z","timestamp":1763534313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1684199\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":25,"alternative-id":["10.3389\/fphar.2025.1684199"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2025.1684199","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,19]]},"article-number":"1684199"}}