Thoracic Paravertebral Block for Perioperative Lung Preservation During VATS pulmonary surgery: Study Protocol of a Randomized Clinical Trial

Abstract

Abstract Background Postoperative pulmonary complications (PPCs) extend the length of stay of patients and increase perioperative mortality after video-assisted thoracoscopic (VATS) pulmonary surgery. Thoracic paravertebral block (TPVB) provides effective analgesia after VATS, however little is known about the effect of TPVB on PPCs. This study aims to determine whether TPVB combined with GA results in reducing PPCs and achieve perioperative lung protection in VATS pulmonary surgery compared with simple general anesthesia. Methods A total of 302 patients undergoing VATS pulmonary surgery will be randomly divided into two groups: Paravertebral block group (PV group) and Control group (C group). Patients of PV group will receive TPVB: 15 ml of 0.5% ropivacaine will be administered to the T4 and T7 thoracic paravertebral spaces respectively before general anesthesia. Patients of C group will not undergo intervention. Both groups of patients adopted protective ventilation strategy during operation. Perioperative protective mechanical ventilation and standard fluid management will be applied in both groups. Patient controlled intravenous analgesia was used for postoperative analgesia. The primary endpoint is the composite outcome of PPCs within 7 days after surgery. Secondary end points include blood gas analysis, postoperative lung ultrasound score, NRS score, QoR-15 score, hospitalization related indicators and long-term prognosis indicators. Discussion This study can better evaluate the impact of the use of TPVB on PPCs and long-term prognosis in patients undergoing VATS lobectomy / segmentectomy. The results may provide clinical evidence for optimizing perioperative lung protection strategies. Trial registration: ID: NCT05922449. Registered on June 25, 2023.