Rib fractures, commonly resulting from blunt thoracic trauma, contribute significantly to patient morbidity related to severe pain and associated complications, including atelectasis, pneumonia, and acute respiratory failure. Effective pain management is crucial for minimizing these complications, optimizing respiratory function, and facilitating recovery. Traditional methods such as NSAIDs, systemic opioids, intercostal nerve blocks, and surgical interventions provide relief but are associated with limitations, including risks of respiratory depression, sedation, infection, and procedural complications. These risks underscore the need for alternative strategies with improved safety profiles. The serratus anterior plane block (SAPB) has emerged as a promising regional anesthesia technique for managing rib fracture pain. Administered under ultrasound guidance, SAPB has shown a low risk of complications such as infection, bleeding, or pneumothorax, enhancing its appeal as a minimally invasive approach. Research has demonstrated SAPB's efficacy in reducing pain scores, minimizing opioid requirements, and improving respiratory function and mobility. By decreasing opioid dependence, SAPB lowers the risk of opioid-related adverse effects and facilitates faster patient recovery. Its favorable safety profile and effectiveness make SAPB a valuable option in managing rib fracture pain, particularly in high-risk populations. Despite its advantages, further studies are needed to optimize SAPB techniques, establish standardized protocols, and investigate long-term outcomes. SAPB represents a significant advancement in rib fracture pain management, highlighting the growing role of regional anesthesia in modern medicine.

Bifid ribs are rare congenital anomalies, usually asymptomatic and discovered incidentally on imaging. However, they can cause significant pain, posing diagnostic and therapeutic challenges, particularly in pediatric populations. We report a case of a 3-year-old female with chronic anterior chest wall pain attributed to a bifid right fourth rib. Imaging confirmed the anomaly without associated soft tissue masses. After transient symptom relief with lidocaine patches and intercostal nerve blocks, she underwent successful percutaneous image-guided cryoneurolysis of the right third to fifth intercostal nerves. The patient experienced marked pain relief post-procedure without complications, with sustained benefit at 4months. Bifid ribs may be an under-recognized cause of intercostal neuralgia in children. Image-guided percutaneous cryoneurolysis may represent a safe and effective treatment option for symptomatic relief.

The management of postoperative pain in patients with lung cancer is a key factor affecting patient comfort and postoperative recovery. The aim of the present review was to compare regional block techniques with traditional analgesic methods, demonstrating their advantages in postoperative analgesia and facilitating patient recovery following thoracoscopic surgery. The effects of different regional analgesic techniques were systematically searched from establishment of the database to April 2024 in Web of Science, Embase and Cochrane. The search strategies were developed using the population, interventions, comparators, outcomes and study design framework, and the results are presented in accordance with the guidelines set out by the preferred reporting items for systematic reviews and meta-analyses statement. The primary outcome was the visual analogue scale (VAS) score, with secondary outcomes including patient self-administered intravenous analgesia, number of patients requiring additional injections of analgesic following surgery and the incidence of adverse reactions as outcome indicators. The present meta-analysis included 14 randomized clinical trials with a total of 1,524 patients and four regional block techniques (paravertebral block, thoracic paravertebral block, serratus anterior plane block, intercostal nerve block). Based on limited evidence, regional block surgery was more effective at relieving postoperative pain and had a lower incidence of adverse reactions, but there was no significant difference in VAS scores between this group and the control group. Compared with the control group, five studies reported a significant decrease in the number of patients requiring additional painkillers following surgery in the group receiving nerve block (I2=14.9%). A total of seven studies showed a significant improvement in the use of patient-controlled analgesia (I2=72.5%); seven studies showed a decrease in nausea and vomiting (I2=22.1%) and four studies reported significant improvement in lung function (I2=44.8%). Other adverse reactions included delirium, drowsiness, venous thrombosis and intestinal obstruction. The present results indicated a significant decrease in various other adverse side effects in the experimental group (I2=46.4%), and there was no notable publication bias. Compared with conventional anesthesia, nerve block techniques in pain management following thoracoscopic surgery for lung cancer decreased the patient-controlled analgesia usage and the number of patients requiring additional postoperative analgesic, but the VAS scores remained inconsistent. In addition, nerve block technology had a lower incidence of postoperative complications and improved the quality of life of patients with cancer.

Postoperative pain remains a significant adverse event after thoracic surgery, to which intraoperative nociception contributes. To measure intraoperative nociception, the Nociception Level (NOL) monitor is one option. This study aims to assess the NOL's utility for measuring intraoperative nociception and predicting acute postoperative pain and opioid consumption. This observational study included 114 thoracic surgery patients (37 thoracotomy, 77 minimally invasive surgery) utilizing two analgesic approaches (40 peridural anaesthesia, 74 intercostal nerve block). NOL's utility to monitor responses to incision and nerve block was assessed at population (Wilcoxon-signed-rank tests) and individual level (ROC-analyses). NOL's predictive utility for postoperative pain and opioid consumption was analysed at population (Mann-Whitney-U tests) and individual level (multivariable linear regression). Population NOL significantly increased after incision and decreased after nerve block (p < 0.01/ p < 0.01) and individual detection of nociception was significantly better than chance (AUCs: 0.68 [95%CI 0.61-0.75] / 0.62 [95%CI 0.53-0.72]). However, NOL did not differ significantly between thoracotomy and minimally invasive surgery (p = 0.12) or peridural anaesthesia and nerve block (p = 0.16), despite significantly different postoperative pain and opioid consumption (p < 0.01). Multivariable analyses showed no significant effect of NOL on postoperative pain or opioid consumption. NOL captures intraoperative stress with an accuracy allowing to differentiate large nociception changes at both the population and individual level after skin incision and nerve block. However, NOL was unable to differentiate between patients with plausibly different nociception levels, like patients undergoing different surgical or analgesic techniques. Consequently, while NOL can detect large nociceptive changes, its current accuracy may be insufficient to reliably guide individual analgesia in clinical practice.

We previously reported results of a randomized trial comparing standard intercostal nerve block (SOC) with SOC plus cryoanalgesia (CRYO) in minimally invasive lung surgery. While no benefit was seen in early postoperative pain or opioid use, CRYO patients had significantly higher Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores at two weeks. We now report one-year follow-up outcomes using LANSS and Visual Analog Scale (VAS). This randomized trial (NCT05348447) enrolled adults undergoing minimally invasive thoracic surgery. SOC patients received intercostal nerve blocks (INB) with bupivacaine and lidocaine. CRYO patients received the same INB plus cryoablation of 5-6 intercostal nerves (120 seconds each). Patients were followed at 3, 6, and 12 months. LANSS scores ≥12 indicated neuropathic pain. Pain severity was assessed using VAS. Follow-up data were available for 76 patients at 3 months (36 SOC, 40 CRYO), 82 at 6 months (42 SOC, 40 CRYO), and 84 at 12 months (44 SOC, 40 CRYO). Median LANSS scores were higher in CRYO at all timepoints: 10 vs. 0.5 (P=0.003), 8 vs. 0 (P<0.001), and 4.5 vs. 0 (P<0.001). At 3, 6, and 12 months respectively, more CRYO patients had LANSS ≥12 (40% vs. 19%, 33% vs. 10%, 30% vs. 5%; P=0.031, 0.010, 0.002), and higher VAS scores were observed at 3 and 6 months (P=0.012, 0.028) but not at 12 months (P=0.168). Cryoanalgesia increased neuropathic pain incidence and severity through one year. Without early clinical benefit, its use in minimally invasive thoracic surgery warrants caution.

Intercostal nerve block is superior than erector spinae plane block after uniportal video-assisted thoracoscopic surgery: randomized controlled trial.

BACKGROUNDSubcutaneous implantable cardioverter-defibrillator (S-ICD) implantation requires effective anesthesia. General anesthesia (GA) carries risks like hemodynamic instability, while ultrasound-guided intercostal nerve block (US-ICNB) may offer better pain control. This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIMTo compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODSThis retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024. They were divided into GA and US-ICNB groups based on anesthesia type. Demographic data, perioperative parameters (operation time, pain scores, analgesic usage), and postoperative outcomes (complications, defibrillation events) were collected and analyzed. Statistical tests were used to compare the two groups.RESULTSThis study included 64 patients (20 in the GA group and 44 in the US-ICNB group). Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group (39.20% ± 12.00% vs 56.20% ± 11.50% in GA, P < 0.001), while American Society of Anesthesiologists scores and comorbidities were comparable. US-ICNB showed superior pain control, with significantly lower numeric rating scale scores at 6-48 hours (P < 0.001) and fewer patients requiring analgesics (P = 0.02). The US-ICNB group had shorter operation times (P < 0.001), total hospital stays (P < 0.001), and later first analgesia times (P < 0.001). No anesthesia-related complications occurred in either group.CONCLUSIONBoth anesthetic methods were safe in the short term. However, US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain. It has high safety in S-ICD implantation and deserves further clinical promotion, though large-scale, multi-center, randomized controlled trials are needed to confirm these findings.

BackgroundThe concept of tubeless anesthesia has emerged as a transformative approach in modern anesthesiology, particularly within the framework of enhanced recovery after surgery (ERAS). However, research regarding the application of tubeless anesthesia in the context of thoracoscopic wedge resection remains limited, particularly with respect to comparative studies of different anesthesia techniques, such as the use of a laryngeal mask airway (LMA) combined with various nerve block approaches. This prospective study evaluated the feasibility and safety of tubeless anesthesia in thoracoscopic wedge resection and its impact on rapid postoperative recovery, providing more evidence for clinical practice.MethodsNinety patients scheduled for thoracoscopic wedge resection were randomized into three groups, with 30 patients in each group: double-lumen endotracheal intubation (Group A), LMA + intercostal nerve block (Group B), and LMA + paravertebral nerve block (Group C). Satisfaction with the surgical field, operation time, hospitalization duration, anesthesia costs, hospitalization costs, postoperative feeding time, and ambulation time were recorded. Intraoperative and postoperative adverse events, perioperative anesthesia-related parameters, hemodynamic variables at five time points [pre-intubation (T0), 3 min post-intubation (T1), at surgery initiation (T2), at surgery completion (T3), and post-extubation (T4)], and arterial blood gas (ABG) indices at four time points [pre-intubation (T0’), 3 min post-intubation (T1’), 45 min post-intubation (T2’), and 1 hour post-surgery (T3’)] were analyzed.ResultsCompared with Group A, Groups B and C presented significantly shorter postoperative feeding times, earlier ambulation, shorter hospitalization durations, and lower anesthesia/hospitalization costs (P<0.05). The incidence of postoperative cough, sore throat, and hoarseness was lower in Groups B and C than in Group A (P<0.05). Compared with those in Group A, the total intubation time, extubation time, and recovery time in Groups B and C were significantly shorter (P<0.05). At T1 and T4, the mean arterial pressure (MAP) and heart rate (HR) were lower in Groups B and C than in Group A (P<0.05). At T2 and T3, the end-tidal CO2 pressure (PETCO2) concentration in Groups B and C was higher than that in Group A (P<0.05). Compared with Group B, Group C presented a lower MAP at T1, T2, and T3 (P<0.05). At T2’, Groups B and C presented a lower pH and higher partial pressure of CO2 (PaCO2) than did Group A (P<0.05), whereas the partial pressure of O2 (PaO2) was higher in Groups B and C at T2’and T3’ (P<0.05).ConclusionsTubeless anesthesia with preserved spontaneous breathing is safe and effective in selected low-risk patients undergoing short-duration thoracoscopic wedge resection, reducing postoperative complications and promoting enhanced recovery.Trial RegistrationChinese Clinical Trial Registry ChiCTR2300073484.

BackgroundStage III tuberculous empyema causes irreversible thoracic pathologies and secondary deformities, with traditional thoracotomy/video-assisted thoracoscopic surgery (VATS) as main treatments. However, its postoperative pain is severe (due to extensive tissue damage) and understudied—existing analgesic research for this population is scarce and biased, while unmanaged pain worsens patient quality of life. This study aimed to evaluate the efficacy of intercostal nerve block (INB) combined with patient-controlled intravenous analgesia (PCIA) for postoperative pain management in patients with stage III tuberculous empyema.MethodsClinical data of 315 patients with tuberculous empyema admitted to Xi’an Chest Hospital from August 9, 2020 to March 25, 2025 were retrospectively analyzed. Patients were divided into group A (n=54, INB + PCIA + oral medications) and group B (n=261, PCIA + oral medications). General clinical data, postoperative Numerical Rating Scale (NRS) scores, frequency of rescue analgesia, postoperative tube indwelling time, drainage volume, and hospitalization costs were compared between groups. Propensity score matching (PSM) was performed to control for confounding factors. Statistical analyses included the t-test, Chi-squared test, rank sum test, etc., and sensitivity analysis was conducted by excluding data from the first two years.ResultsThe 24-hour postoperative NRS score was 2.00 (2.00, 3.00) in group A vs. 3.00 (2.00, 3.00) in group B (Z=−3.93; P<0.001). The maximum postoperative NRS score was 3.00 (2.00, 4.00) in group A vs. 4.00 (3.00, 4.00) in group B (Z=−2.80; P=0.005). Post-extubation NRS scores were 1.00 (0.00–1.00) in both groups (Z=−0.07; P=0.95). The frequency of postoperative rescue analgesia was 0.00 (0.00, 0.00) in group A vs. 0.00 (0.00, 1.00) in group B (Z=−2.43; P=0.02). No significant differences were observed in 24-hour thoracic drainage volume, total drainage volume, thoracic drainage tube indwelling time, postoperative discharge time, or total hospitalization costs (all P>0.05).ConclusionsIn patients with stage III tuberculous empyema, INB administered before chest closure combined with PCIA and oral medications enhances postoperative analgesic efficacy and reduces the need for rescue analgesia.

BackgroundVideo-assisted thoracoscopic surgery (VATS) offers reduced postoperative pain and faster recovery, yet optimal analgesia remains essential. Regional anesthesia techniques, such as the erector spinae plane (ESP) block and intercostal nerve block (ICNB), are commonly employed. This study compares preoperative ESP block with surgeon-performed intraoperative ICNB in VATS patients.MethodsIn this retrospective study, 82 patients (≥ 18 years; ASA I–III) underwent elective VATS between January 2020 and December 2022 were analyzed. Forty patients received a postoperative ESP block and 42 an intraoperative ICNB. Primary outcomes included postoperative pain scores using the Visual Analog Scale, postoperative peak expiratory flow (PEF), postoperative IV opioid analgesic use, drainage time, and hospital length of stay.ResultsBaseline demographics were similar. VAS scores were comparable at postoperative 1, 3, 6, 12 and 24 h. At postoperative 48 h, the ICNB group had significantly lower VAS scores (4.17 ± 1.03 vs. 4.78 ± 1.03; p = 0.00987). No significant differences were observed in postoperative iv opioid analgesic use, drainage time or hospital stay.ConclusionsBoth techniques provide effective early analgesia in VATS, with ICNB showing prolonged pain relief. Further prospective studies are warranted.

BackgroundEffective postoperative pain control is essential for recovery after surgery. This study aimed to evaluate the safety and efficacy of a modified continuous intercostal nerve block (MCINB) compared to conventional intravenous analgesia pump (IAP) for pain management following uniportal thoracoscopic lung resection.MethodsWe retrospectively analyzed patients who underwent uniportal thoracoscopic lung resection at our center between January 2020 and December 2023. Patients were divided into two groups based on the actual analgesia method used postoperatively: MCINB and IAP. The MCINB technique involved placing a multi-orifice catheter in the intercostal space under thoracoscopic guidance, with continuous infusion of local anesthetic. We compared postoperative numeric rating scale (NRS) pain scores at rest and during coughing, patient satisfaction with pain management, frequency of rescue analgesic use, analgesic-related side effects, catheter-related complications, length of hospital stay, and total medical costs.ResultsAmong the 458 included patients, 196 received MCINB, and 262 received IAP. Linear mixed-effects model analysis showed that NRS pain scores at rest and during coughing were significantly lower in the MCINB group over the postoperative period (p < 0.001), with post hoc comparisons revealing no significant difference immediately after surgery and on the day of discharge (p > 0.05). At other time points, the median NRS scores in the MCINB group remained within the mild pain range. Patient satisfaction with pain management was significantly higher in the MCINB group than in the IAP group (90.3% vs. 65.6%, p < 0.001). Additionally, the MCINB group had a shorter hospital stay, lower total medical costs, reduced rescue analgesic use, and fewer analgesic-related side effects (p < 0.001). The incidence of intercostal catheter dislodgement and blockage was 1% (2/196) each, with no severe catheter-related complications reported.ConclusionMCINB appears to be a safe and effective option for early postoperative pain management after uniportal thoracoscopic surgery.

Percutaneous nephrolithotomy (PCNL) is a common surgical procedure for the removal of kidney stones. Adequate postoperative analgesia is crucial for enhancing recovery and minimizing complications. Peripheral nerve blocks (PNBs) have emerged as a promising method for managing postoperative pain in PCNL patients. This systematic review and network meta-analysis (NMA) aim to evaluate the efficacy of various PNBs for analgesia after PCNL. A comprehensive literature search was conducted in electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library up to April 2025. Randomized controlled trials (RCTs) that compared different PNBs or PNBs with no block after PCNL were included. The primary outcome was the total morphine consumption within the first 24 hours postoperatively. The NMA was performed using Stata 15.1 software. We included 38 RCTs involving 2,339 patients and assessed seven analgesic techniques. The total morphine consumption was most significantly reduced by intercostal nerve block (ICNB), followed by peritubal infiltration (PI) and erector spinae plane block (ESPB). At 6 hours postoperatively, the resting Visual Analog Scale (VAS) scores were lower with ICNB, followed by PI and ESPB. At 12 hours, resting VAS scores decreased with paravertebral block (PVB), followed by ICNB and PI. At 24 hours, resting VAS scores were reduced by PVB, then epidural block (EB), and ICNB. For dynamic-induced pain at 6 hours, VAS scores were decreased by quadratus lumborum block (QLB), followed by ICNB and PI. At 12 hours, dynamic VAS scores were lower with ESPB, followed by ICNB and PI. At 24 hours, dynamic VAS scores decreased with PVB, followed by EB and ICNB. Postoperative nausea and vomiting (PONV) were reduced by ICNB, followed by PI and PVB. The time to first rescue analgesia was prolonged with ICNB, followed by QLB and PI. The number of patients requiring additional analgesics were decreased with ICNB, followed by PI and QLB. The NMA indicated that ICNB was likely the optimal technique for postoperative analgesia in patients undergoing PCNL. In contrast, the TAPB appears to be less effective.

Objective: Intraoperative nefopam infusion was documented as safe and viable for supplemental pain management, alongside opioids following surgery. Postoperative pain control with nefopam after video-assisted thoracoscopic surgery (VATS) is not well understood. This study assessed the effects of nefopam towards postoperative morphine requirements and pain intensity 24 hours after VATS lobectomies. Materials and Methods: This multicenter, double-blind, randomized, controlled trial enrolled 18-70-year-old elective VATS lobectomy patients. Patients were randomized 1:1, receiving nefopam or normal saline solution (NSS) administered during the maintenance of anesthesia and 24-hour postoperative period. All received multimodal analgesia, including paracetamol, ibuprofen, and intercostal nerve blocks. Postoperative morphine was administered via patient-controlled analgesia (PCA) devices and recorded at 10 and 30 minutes, and 1, 2, 6, 12, 18 and 24 hours.Postoperative pain was graded at rest and during deep breathing using numeric rating scale (NRS) scores 1, 2, 12, and 24 hours. Results: Of 72 enrolled patients, 70.8% were female, with a mean (± standard deviation) age of 56.5 ± 10.4 years. No significant postoperative difference was observed between groups for: total median (P25, P75) morphine amounts administered over 24 hours (nefopam, 14 [8, 24] mg; control, 8 [4.5, 19] mg; p = 0.17); NRS pain scores during rest (p = 0.98) or deep breathing (p = 0.82) 1, 2, 12, and 24 hours Conclusion: Intraoperative and postoperative nefopam infusion, including multimodal analgesia, did not reduce morphine consumption or NRS pain scores in VATS lobectomy, but may have prolonged the duration of pain relief.

BACKGROUND: In thoracic surgery, pain intensity resulting from nociceptive stimulation due to skin incision, muscle trauma, rib retraction, and pleural dissection contributes to central sensitization and the development of severe postoperative pain, particularly in the early postoperative period. Intrathecal administration of morphine represents an alternative opioid-sparing component of multimodal acute pain management. AIM: The work aimed to clinically evaluate the analgesic efficacy of intrathecal morphine in patients undergoing thoracic surgery. METHODS: The study included 255 patients who underwent thoracoscopic lobectomy. Patients were allocated into three groups: group 1 (n = 85) received intrathecal morphine; group 2 (n = 85) received systemic opioid analgesics; and group 3 (n = 85) received intercostal nerve blockade with ropivacaine. Pain intensity was assessed 2 and 24 hours postoperatively, along with the need for rescue analgesia (trimeperidine or tramadol) and the incidence of postoperative nausea and vomiting, pruritus, urinary retention requiring bladder catheterization, and delayed respiratory depression. RESULTS: Two hours after surgery, pain intensity was lowest in the intercostal nerve block group (4 [3–4] cm on the visual analog scale [VAS]) and slightly higher in the intrathecal morphine group (4 [4–5] cm on the VAS). Both groups demonstrated a significantly greater analgesic effect compared with the systemic opioid analgesia group (6 [5–6] cm on the VAS; p 0.001). At 24 hours postoperatively, pain intensity in group 1 decreased to 3 [2–3] cm on the VAS, whereas in group 2 it increased to 6 [5–6] cm, comparable with group 3 (6 [5–6] cm; p 0.001). Trimeperidine consumption was significantly lower in group 1 (p 0.001). The frequency of tramadol administration was also reduced (p 0.001). The highest incidence of postoperative nausea and vomiting was observed in group 2 (p 0.001). The incidence of pruritus and urinary retention did not differ significantly among groups. No cases of delayed respiratory depression were reported. CONCLUSION: Intrathecal administration of morphine significantly reduced pain intensity, decreased the need for opioid analgesics, and was associated with a low incidence of pruritus within the first 24 hours after surgery. The incidence of postoperative nausea and vomiting was lower compared with both systemic opioid analgesia and intercostal nerve block. The need for urinary catheterization did not differ among groups. No delayed respiratory depression was observed.

ObjectiveThis study aimed to evaluate and compare the analgesic efficacy of liposomal bupivacaine (LB) versus conventional bupivacaine hydrochloride for intercostal nerve block after thoracoscopic surgery.DesignA prospective, randomized, controlled, single-blind study.SettingThe study was conducted in the operating room, post-anesthesia care unit (PACU), and general ward.ParticipantsA total of 100 patients classified as ASA physical status II–III who were scheduled for thoracoscopic surgery were enrolled.InterventionsParticipants were randomly allocated to receive either LB or conventional bupivacaine hydrochloride via intercostal nerve block, performed under ultrasound guidance. All patients received intravenous patient-controlled analgesia (PCA) without a continuous background infusion. Rescue morphine was administered as needed if the PCA failed to provide adequate pain relief (VAS ≥ 4).MeasurementsThe primary outcome was postoperative pain intensity assessed using the Visual Analog Scale (VAS; 0–10) both at rest and during exercise at 6, 8, 12, 24, 48, and 72 h after surgery. Secondary outcomes included total morphine consumption, PCA demand frequency, patient satisfaction scores, intraoperative remifentanil dose, and length of hospital stay. Safety outcomes included the incidence of postoperative nausea and vomiting (PONV), pruritus, pulmonary complications, and cardiovascular events.ResultsBaseline characteristics and surgical procedures were comparable between groups. Compared with conventional bupivacaine, the LB group showed significantly lower VAS scores at rest and during exercise at all six postoperative time points (6–72 h; all p < 0.01). PCA demand frequency was significantly reduced in the LB group (median: 11 vs. 30 presses; p < 0.01). Patient satisfaction scores were significantly higher in the LB group (median: 9.0 vs. 7.0; p < 0.01). No significant differences were observed in intraoperative remifentanil consumption (p = 0.088) or postoperative hospital stay (p = 0.135). Rescue morphine requirements were minimal in both groups (median: 0 doses).ConclusionLB provided sustained and effective postoperative analgesia for 72 h after thoracoscopic surgery, while significantly reducing opioid consumption (p < 0.01) and supplemental analgesic requirements compared to conventional bupivacaine.Clinical trial registrationwww.chictr.org.cn, ChiCTR2300076708.

Objectives:Rib fractures, which are among the most common injuries in blunt thoracic trauma, are commonly encountered in emergency departments. Pain management of rib fractures is a challenge for physicians. Oral analgesics and invasive modalities like intercostal nerve block or operative repair still have some controversies and present limited pain relief. Kinesiotape (KT) is a drug-free elastic therapeutic tape used for treating various musculoskeletal injuries especially in sports medicine. The objective of this study is to evaluate the effects of kinesiotaping on several parameters of patients with rib fracture.Methods:This study was conducted in accordance with the Synthesis without meta-analysis (SWiM) guideline. Several studies were selected from Medline, Google Scholar, and Cochrane Central Libraries. Seven independent reviewers assessed the quality of the included studies using critical appraisal tool.Results:One NRCT, two cohort studies, and four case reports were analyzed in this study. It discovered that the use of kinesiotape was effective in terms of pain reduction in rib fractures.Conclusion:Kinesiotaping can be used in pain management of isolated rib fractures. Additional research need to investigate the role of taping interventions for treating various skeletal injuries.

In thoracic surgery, general anesthesia remains the standard approach. During the procedure, one-lung ventilation using double-lumen tubes or bronchial blockers is employed as needed. For postoperative pain control, a multimodal approach is taken, incorporating options such as thoracic epidural anesthesia, paravertebral blocks, intercostal nerve blocks, and intravenous patient-controlled analgesia (IV-PCA). These practices have remained consistent in recent years. However, anesthetics and anesthesia-related devices including physiological monitors and ultrasound machines have continued to evolve. As a result, anesthesia today differs significantly from that of a decade ago. This section highlights the latest advances in anesthetics and anesthesia-related technologies, including: (1) the use of artificial intelligence (AI) for monitoring and decision support, (2) robotic anesthesia systems with automated drug delivery, (3) remimazolam as a novel ultra-short-acting sedative, and (4) autologous blood recovery systems capable of platelet collection, improving hemostasis and reducing transfusion requirements. Although the clinical efficacy of these innovations remains to be established through future research, there is considerable anticipation surrounding their potential to enhance the quality of anesthesia management.

Efficacy and safety of hydromorphone caudal block combined with intercostal nerve block during VATS: a single-center randomized controlled study.

Even minimally invasive thoracic surgeries carry a postoperative cost in pain. While regional anesthesia may alleviate this anticipated pain, especially intercostal nerve blocks (ICNB), the timing of block administration for optimal effect (at the beginning of surgery vs. before wound closure) remains controversial. Here, we plan (1) to test the hypothesis that performing ICNB at the beginning of surgery provides superior postoperative analgesic effects compared to before wound closure and (2) to observe perioperative outcomes to determine whether the timing affects acute and chronic postoperative pain, or intraoperative patient management. This single-blinded, single-center, randomized, controlled trial will be conducted at the Department of Thoracic Surgery, University of Tsukuba Hospital from Sep 29, 2024, to June 30, 2026. Patients 16-79years old within the regular population of patients undergoing lung wedge resection via video-assisted thoracoscopic surgery (VATS) without a utility window approach and who are ASA-PS classes 1-3 will be enrolled to receive ICNB either pre-operatively or before wound closure. Groups will be single-blinded (patient only) at random, and the primary outcome will be assessment by Numerical Rating Scale (NRS) pain scores during movement, measured 4h after returning to the ward. Secondary outcomes will be (1) any additional analgesic use within the 4-h return window, (2) intraoperative measurements (including amounts of remifentanil used, time from surgery completion to extubation, occurrence of shivering or nausea after extubation, use of antiemetics, and maximum blood pressure/heart rate), (3) acute pain during hospitalization (using routinely administered NRS), (4) postoperative analgesic use, and (5) quality of life (QOL) scores on EQ-5D and SF-36 questionnaires at preoperative and 3-month postoperative timepoints. Chronic pain at 3months post-surgery will also be determined by NRS. A complete evaluation of ICNB efficacy as a preemptive analgesic approach will contribute to the development of improved perioperative pain management techniques. A reduction in the duration of surgery-related symptoms and an improvement in postoperative QOL will be the result. Japan Registry of Clinical Trials: identifier jRCT1031240358.Registered on 29 Sep 2024. https://jrct.niph.go.jp/latest-detail/jRCT1031240358 .

BackgroundTo evaluate the analgesic effects between thoracic epidural block (TEB) and conscious sedation with intercostal nerve block (CSINB) in patients undergoing thermal lung tumor ablation.MethodsMedical records of patients with primary or secondary lung tumors who underwent thermal lung tumor ablation between 2011 and 2022 were reviewed. Primary outcome measures were pain intensity evaluated using the visual analog scale (VAS) and additional morphine use within 48 hours after the procedure. Secondary outcome measures were adverse events during and after surgery.ResultsAmong 72 patients (median age 68, 61.1% male), 31 received CSINB and 41 received TEB. The TEB group had significantly fewer patients with VAS ≥ 5 (2.4% vs 25.8%, p = 0.004) and less additional morphine use (24.4% vs 77.4%, p < 0.001). Multivariable analysis showed that TEB reduced the risk of post-procedural pain (adjusted odds ratio [aOR], 0.04; 95% confidence interval [CI], 0.003–0.47) and additional morphine use (aOR: 0.08, 95% CI: 0.02–0.28). Hypotension occurred in 35 TEB patients and nausea in 5, both effectively managed with vasopressors and antiemetics. The incidence of fever, pneumothorax, pleural effusion, and pigtail drainage was similar between groups (p > 0.05).ConclusionTEB provides superior analgesia compared to CSINB. Although patients with reduced pulmonary function were not analyzed as a separate subgroup, the favorable analgesic outcomes and absence of respiratory depression in the TEB group—including those with prior lobectomy and limited pulmonary reserve—indicate that this technique may be appropriate for patients with compromised respiratory function.