Opioid-sparing analgesia in thoracic oncology surgery: The role of paravertebral block in a high opioid use context in human patients

Abstract

Introduction: This pilot study aimed to evaluate whether thoracic paravertebral block (PVB) offers better postoperative analgesia than systemic morphine in thoracotomy patients, focusing on early pain scores, rescue analgesia needs, and postoperative nausea and vomiting (PONV). Materials and Methods: We analyzed 51 thoracic surgery patients; 24 received a single-shot ultrasound-guided PVB with bupivacaine before incision, while 27 were administered intraoperative systemic morphine. Pain was assessed using the Numeric Rating Scale (NRS) at 0, 3, 6, and 12 hours, along with tracking PONV, intraoperative opioid use, and hemodynamic parameters. Results: Pain scores were lower in the PVB group at all intervals (p = 0.022 at 0h, p = 0.004 at 3h, p = 0.008 at 6h, and p = 0.009 at 12h). By 12 hours, 50% of patients in the PVB group required no rescue analgesia compared to 3.7% in the morphine group (p = 0.008). PONV occurred less frequently in the PVB group (20.8% vs. 44.4%), demonstrating a clinical trend, though the difference did not reach statistical significance (p = 0.074). Intraoperative fentanyl consumption was significantly reduced in the PVB group (p < 0.001). Hemodynamic parameters were similar between groups. Conclusion: PVB provided more effective pain relief than systemic morphine after thoracotomy, with reduced opioid consumption and a trend toward less PONV. These findings support PVB's role in enhancing postoperative recovery in thoracic surgery.