{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:31:53Z","timestamp":1765211513622,"version":"3.46.0"},"reference-count":33,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Thoracic paravertebral block (TPVB) is an established component of multimodal analgesia and enhanced recovery pathways following thoracoscopic lung resection. A surgeon-performed, thoracoscopy-guided approach has been proposed to improve intraoperative workflow, but high-quality comparative data are limited. Methods: In this single-center, randomized, non-inferiority trial, adult patients undergoing thoracoscopic lobectomy or segmentectomy received either thoracoscopy-guided TPBV (T-TPVB) conducted by surgeons or ultrasound-guided TPBV (U-TPVB) conducted by anesthesiologists. Blocks were performed at the end of surgery at the T4 and T7 vertebra levels, using 10 mL of 0.5% ropivacaine per level. The primary outcome was dynamic pain during coughing at 1\u20136 h postoperatively (visual analog scale, VAS). Secondary outcomes included resting\/dynamic pain scores, opioid consumption over 48 h, block-related complications, and procedural time. Results: Seventy-three patients were included in the intention-to-treat analysis. Mean dynamic VAS scores at 1\u20136 h were 3.3 (T-TPVB) and 3.1 (U-TPVB), with a mean difference of 0.2 (95% CI: \u22120.3 to 0.7), meeting the non-inferiority criterion (margin 0.9). Secondary outcomes, including pain trajectories and opioid consumption, were comparable between groups. Procedural time was significantly shorter in the T-TPVB group, with no differences in complication rates. Conclusions: Surgeon-performed thoracoscopy-guided TPVB was non-inferior to the standard ultrasound-guided technique for early postoperative pain after thoracoscopic lung resection. Both methods provided comparable analgesic efficacy and safety profiles, while T-TPVB significantly reduced procedural time. This approach may support streamlined perioperative workflows and optimize enhanced recovery protocols in thoracic surgery. (Trial registration number, KCT0006471).<\/jats:p>","DOI":"10.3390\/jcm14238493","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracoscopy-Guided vs. Ultrasound-Guided Paravertebral Block in Thoracoscopic Surgery: A Non-Inferiority Randomized Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4603-7438","authenticated-orcid":false,"given":"Seok Beom","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2103-3122","authenticated-orcid":false,"given":"Kwanyong","family":"Hyun","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-9458","authenticated-orcid":false,"given":"Hoon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS\u00ae) Society and the European Society of Thoracic Surgeons (ESTS)","volume":"55","author":"Batchelor","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.bjae.2023.05.001","article-title":"Regional analgesia for acute pain relief after open thoracotomy and video-assisted thoracoscopic surgery","volume":"23","author":"Mehta","year":"2023","journal-title":"BJA Educ."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1053\/j.jvca.2017.10.003","article-title":"Paravertebral Block for Thoracic Surgery","volume":"32","author":"Arora","year":"2018","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1213\/ANE.0000000000006441","article-title":"Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1","volume":"137","author":"Makkad","year":"2023","journal-title":"Anesth. Analg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1186\/s13019-024-02877-7","article-title":"Comparative analysis of the analgesic effects of intercostal nerve block, ultrasound-guided paravertebral nerve block, and epidural block following single-port thoracoscopic lung surgery","volume":"19","author":"Shen","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1186\/s13019-023-02343-w","article-title":"Comparison of erector spinae plane block with paravertebral block for thoracoscopic surgery: A meta-analysis of randomized controlled trials","volume":"18","author":"Pang","year":"2023","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jamasurg.2025.1899","article-title":"Intercostal or Paravertebral Block vs Thoracic Epidural in Lung Surgery: A Randomized Noninferiority Trial","volume":"160","author":"Spaans","year":"2025","journal-title":"JAMA Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1007\/s40122-024-00648-9","article-title":"The Impact of Different Regional Anesthesia Techniques on the Incidence of Chronic Post-surgical Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Network Meta-analysis","volume":"13","author":"Zhao","year":"2024","journal-title":"Pain Ther."},{"key":"ref_10","doi-asserted-by":"crossref","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":"ref_11","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s40122-020-00231-y","article-title":"Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial","volume":"10","author":"Hu","year":"2021","journal-title":"Pain Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.athoracsur.2018.04.036","article-title":"Patient-Controlled Paravertebral Block for Video-Assisted Thoracic Surgery: A Randomized Trial","volume":"106","author":"Wu","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1053\/j.jvca.2015.06.013","article-title":"Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial","volume":"29","author":"Zhang","year":"2015","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s40122-024-00593-7","article-title":"Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial","volume":"13","author":"Xu","year":"2024","journal-title":"Pain Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1001\/jamasurg.2023.5228","article-title":"Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery: A Randomized Clinical Trial","volume":"158","author":"Chenesseau","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e13771","DOI":"10.1097\/MD.0000000000013771","article-title":"The efficacy of thoracic paravertebral block for thoracoscopic surgery: A meta-analysis of randomized controlled trials","volume":"97","author":"Hu","year":"2018","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chu, H., Dong, H., Wang, Y., and Niu, Z. (2020). Effects of ultrasound-guided paravertebral block on MMP-9 and postoperative pain in patients undergoing VATS lobectomy: A randomized, controlled clinical trial. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-00976-1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/ALN.0000000000000747","article-title":"Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review","volume":"123","author":"Krediet","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/bja\/aew466","article-title":"Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state","volume":"118","author":"Myles","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_20","first-page":"196","article-title":"Thoracic paravertebral block: Influence of the number of injections","volume":"31","author":"Naja","year":"2006","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"De Cassai, A. (Anaesthesia, 2025). The ratio of confidence interval above the minimal clinically important difference, Anaesthesia, in press.","DOI":"10.1111\/anae.70028"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.athoracsur.2023.07.038","article-title":"Paravertebral vs Epidural Anesthesia for Video-assisted Thoracoscopic Surgery: A Randomized Trial","volume":"116","author":"Wu","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"567","DOI":"10.4103\/jmas.jmas_261_21","article-title":"The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung","volume":"18","author":"Kang","year":"2022","journal-title":"J. Minim. Access Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/rapm-2022-103751","article-title":"Core outcome set for peripheral regional anesthesia research: A systematic review and Delphi study","volume":"47","author":"Hill","year":"2022","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1097\/j.pain.0000000000002254","article-title":"Developing consensus on core outcome domains for assessing effectiveness in perioperative pain management: Results of the PROMPT\/IMI-PainCare Delphi Meeting","volume":"162","author":"Liedgens","year":"2021","journal-title":"Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1177\/0218492320965015","article-title":"Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy","volume":"29","author":"Hegazy","year":"2021","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4115","DOI":"10.21037\/jtd-20-1068B","article-title":"Paravertebral block with modified catheter under surgeon\u2019s direct vision after video-assisted thoracoscopic lobectomy","volume":"12","author":"Xu","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1055\/a-2062-0264","article-title":"Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial","volume":"37","author":"Chaiperm","year":"2024","journal-title":"J. Knee Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1097\/ACO.0000000000000643","article-title":"Regional anesthesia by nonanesthesiologists","volume":"31","author":"Pawa","year":"2018","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1016\/j.arth.2024.03.064","article-title":"Intraoperative Surgeon-Administered Adductor Canal Block Is a Safe Alternative to Preoperative Anesthesiologist-Administered Adductor Canal Block in Primary Total Knee Arthroplasty","volume":"39","author":"Samuel","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Fuller, A.M., Bharde, S., and Sikandar, S. (2023). The mechanisms and management of persistent postsurgical pain. Front. Pain Res., 4.","DOI":"10.3389\/fpain.2023.1154597"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1053\/j.jvca.2018.07.004","article-title":"Early Versus Late Paravertebral Block for Analgesia in Video-Assisted Thoracoscopic Lung Resection. A Double-Blind, Randomized, Placebo-Controlled Trial","volume":"33","author":"Kamalanathan","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e312","DOI":"10.1016\/j.bja.2019.03.024","article-title":"Objective monitoring of nociception: A review of current commercial solutions","volume":"123","author":"Ledowski","year":"2019","journal-title":"Br. J. Anaesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8493\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:27:05Z","timestamp":1765211225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,30]]},"references-count":33,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238493"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238493","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,30]]}}}