Efficacy of Methylene Blue Thoracic Paravertebral Block in Postoperative Pain After VATS Lobectomy

Abstract

BackgroundParavertebral block (PVB) is effective in controlling postoperative pain after video-assisted thoracoscopic surgery (VATS) lobectomy but is subject to a high rate of failure because of incorrect site of injection. We compared methylene blue PVB with thoracic epidural anesthesia (TEA) for postoperative pain after VATS lobectomy. MethodsWe conducted a prospective randomized trial of patients undergoing VATS lobectomy; 120 patients were randomly assigned to the PVB or TEA group. The end points were postoperative pain at 1 hour, 12 hours, 24 hours, and 48 hours; time to perform TEA and PVB; opioid consumption; and postoperative outcomes. ResultsPVB was associated with reduction of local anesthesia time (P < .0001). In 2 cases, methylene blue showed that the block was not well performed; thus, it was repeated. No significant differences were found in postoperative pain, opioid consumption, and postoperative outcomes. ConclusionsPVB with methylene blue is as effective as TEA for controlling postoperative pain. Methylene blue use could help reduce PVB failure.