{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:46:51Z","timestamp":1782362811647,"version":"3.54.5"},"reference-count":16,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"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: Acute pain after video-assisted thoracoscopic surgery (VATS) promotes respiratory splinting, impaired cough, and pulmonary complications, and predicts persistent opioid use. Surgeon-administered intercostal nerve block (ICNB) is a simple regional technique, but its independent effect on early pain and opioid requirement in a contemporary uniportal VATS (UVATS) pathway is incompletely defined. Methods: We performed a retrospective cohort study of 456 consecutive patients undergoing UVATS at a single Israeli center between 2017 and 30 May 2025. Patients receiving an intercostal block were compared with those who did not. Baseline covariates were balanced by 1:1 nearest-neighbor propensity-score matching (caliper 0.2 SD of the logit propensity score). The primary endpoints were pain on postoperative day (POD) 1 (visual analog scale, VAS) and postoperative opioid use; secondary endpoints included later pain, analgesic regimen, postoperative pneumonia, and mortality. Results: Matching yielded 159 patients per group (n = 318) with all clinically relevant covariates balanced (standardized mean difference [SMD] &lt; 0.13). Median POD1 VAS was lower with the block (4 [IQR 3\u20134] vs. 5 [5\u20137]; p &lt; 0.001), and 76.1% of block patients were opioid-free versus 10.7% who were not (p &lt; 0.001). The effect was concentrated early and attenuated by POD3. In multivariable analysis the block was independently associated with lower POD1 VAS (adjusted \u03b2 = \u22121.64, 95% CI \u22122.00 to \u22121.29; p &lt; 0.001). Postoperative pneumonia was less frequent in the block group (5.7% vs. 20.1%; p &lt; 0.001). Thirty-day and one-year mortality did not differ significantly. Conclusions: In UVATS, a surgeon-placed intercostal nerve block was associated with lower early postoperative pain that persisted after adjustment for operating surgeon and surgical era, concordant with pooled meta-analytic estimates; associated reductions in opioid use and pneumonia were confounded with surgeon and secular trend and are hypothesis-generating. These single-center, retrospective findings require prospective, protocol-randomized confirmation.<\/jats:p>","DOI":"10.3390\/jcm15134910","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T03:20:21Z","timestamp":1782357621000},"page":"4910","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intercostal Nerve Block in Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity-Score Matched Single-Center Study of Early Postoperative Pain and Opioid Use"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9754-5028","authenticated-orcid":false,"given":"Fahim","family":"Kanani","sequence":"first","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6090-1570","authenticated-orcid":false,"given":"Narmin","family":"Zoabi","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Gastroenterology Shiba Medical Center, Ramat Gan 5265601, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Khabarov","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Thoracic Surgery, The Edith Wolfson Medical Center, 62 Ha-Lokhamim Street, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoey","family":"Berdan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Thoracic Surgery, The Edith Wolfson Medical Center, 62 Ha-Lokhamim Street, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6889-9049","authenticated-orcid":false,"given":"Moshe","family":"Argaman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirit","family":"Meller","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rijini","family":"Nugzar","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Anaesthesia, The Edith Wolfson Medical Center, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Fruchter","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Pneumonology, The Edith Wolfson Medical Center, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1105-3218","authenticated-orcid":false,"given":"Mohammad Eid","family":"Al Mohtasib","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Thoracic Surgery, The Edith Wolfson Medical Center, 62 Ha-Lokhamim Street, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mordechai","family":"Shimonov","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Salhab","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Thoracic Surgery, The Edith Wolfson Medical Center, 62 Ha-Lokhamim Street, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9478-5628","authenticated-orcid":false,"given":"Moshe","family":"Kamar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2630-9546","authenticated-orcid":false,"given":"Firas","family":"Abu Akar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Edith Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Thoracic Surgery, The Edith Wolfson Medical Center, 62 Ha-Lokhamim Street, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.thorsurg.2020.03.001","article-title":"Pain management in thoracic surgery","volume":"30","author":"Marshall","year":"2020","journal-title":"Thorac. 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Pain"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s40814-021-00801-7","article-title":"Continuous erector spinae plane block versus intercostal nerve block in patients undergoing video-assisted thoracoscopic surgery: A pilot randomized controlled trial","volume":"7","author":"Horth","year":"2021","journal-title":"Pilot Feasibility Stud."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2133394","DOI":"10.1001\/jamanetworkopen.2021.33394","article-title":"Assessment of intercostal nerve block analgesia for thoracic surgery: A systematic review and meta-analysis","volume":"4","author":"Privorotskiy","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s13019-023-02243-z","article-title":"Efficacy of preemptive intercostal nerve block on recovery in patients undergoing video-assisted thoracic lobectomy","volume":"18","author":"Chen","year":"2023","journal-title":"J. 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