Patient-reported EORTC QLQ C-30 global health status decline predicts survival after video-assisted thoracoscopic (VATS) lung resection and stereotactic ablative radiotherapy (SABR): A 5year follow-up from the Lilac study.

We present a case of a rare pulmonary lesion in a 57-year-old male. A thoracic computed tomography (CT) scan revealed a cystic-solid nodule in the right lower lobe. The patient underwent right lower lobe wedge resection via video-assisted thoracoscopic surgery (VATS). Postoperative pathological examination showed an extremely rare condition known as placental transmogrification of the lung (PTL). The patient had an excellent postoperative prognosis and was followed up for 1 year without surgical complications or recurrence. Given that PTL is frequently misdiagnosed as a malignant tumor, this article systematically discusses its clinical manifestations, imaging characteristics, and pathological definition based on existing literature. The aim is to raise awareness of this disease among clinicians, radiologists, and pathologists, thereby avoiding unnecessary overtreatment.

Uniportal video-assisted thoracoscopic surgery (uVATS) provides excellent postoperative outcomes but limits instrument triangulation, making vascular stapling particularly challenging. We developed a simple "pulley technique" using a loop ligature device to create gentle, multidirectional, and dynamically adjustable traction during pulmonary vessel division. This technique involves passing a vessel tape around the target vessel through a loop ligature device and externalizing the tape to allow controlled retraction. The system stabilizes the vessel, improves the angle for stapler insertion, and minimizes the risk of overstretching. Compared with conventional traction methods, the pulley mechanism reduces instrument collision and provides more predictable tension distribution. The technique was successfully applied in multiple lobectomies and segmentectomies without vascular injury or conversion. Its simplicity, reproducibility, and low cost make it a valuable adjunct for improving safety and efficiency in uVATS.

Background: Chronic pain following thoracotomy remains a common and clinically significant complication that adversely affects functional recovery and quality of life. Despite advances in perioperative analgesic techniques, chronic post-thoracotomy pain continues to be under-recognized and insufficiently managed in routine clinical practice. In this study, we aimed to determine the incidence of chronic pain after thoracotomy and evaluate its impact on daily activities and postoperative pain management behaviors. Methods: This retrospective observational study was conducted after institutional ethics committee approval was received (approval no. 2023/61). Patients aged ≥15 years who underwent thoracotomy between 15 June 2022 and 15 June 2023 and had undergone an operation at least three months prior to the study were included. Patients who underwent video-assisted thoracoscopic surgery were excluded. Demographic, surgical, anesthetic, and postoperative analgesia data were obtained from medical records. Patients were contacted by telephone to assess pain intensity using a Numeric Rating Scale (NRS), functional impact on daily activities, and analgesic medication use. The primary outcome was the incidence of chronic post-thoracotomy pain, defined as pain persisting beyond three months and reported at the time of the interview. Results: A total of 56 patients were included in the analysis. Chronic pain was reported by 55.4% of the patients. Pain that interfered with daily activities and required medication use was reported by 51.5% of the patients. Thirty-three patients (57.9%) reported an NRS score > 3 during movement. Among patients with chronic pain, 64.7% reported self-medication without physician consultation, whereas only 11.8% sought medical advice for pain management. Conclusions: Chronic pain remains highly prevalent after thoracotomy and substantially interferes with daily functioning. A considerable proportion of patients self-manage their pain without medical supervision, underscoring the need for structured postoperative follow-up, early identification of high-risk patients, and individualized multimodal analgesic strategies to reduce the burden of chronic post-thoracotomy pain.

Chronic postsurgical pain (CPSP) is a significant burden affecting ∼30% of patients after video-assisted thoracoscopic surgery (VATS). The introduction of machine learning (ML) might improve our prediction models of CPSP, but studies are needed to compare the different ML models. It appears likely that a multimodal ML model would be better compared with a single-modal model, but this is yet to be explored. This study evaluated different ML prediction models for CPSP after VATS using a multivariable approach. The study included patients scheduled to VATS. Preoperative assessments were performed within 4 domains included demographic variables, psychological factors, quantitative sensory testing, and inflammatory biomarkers. CPSP was assessed 1 year after surgery. Five ML techniques were applied: multiple logistic regression with backward elimination, Kernel k-Nearest Neighbors (kKNN), kKNN with variable elimination using Random Forest, Naive Bayesian Classifier, and Gradient Boosting. The models were applied across the 4 domains of predictors. Models were internally validated using leave-one-out cross-validation. This study enrolled 100 patients, with 86 completing the 12-month follow-up. Results showed varying area under the receiver operating characteristics curve (ROCAUC) across models and domains, ranging from 0.500 (95% CI: 0.500-0.500) to 0.965 (95% CI: 0.896-1.000), with Gradient Boosting demonstrating the highest ROCAUC. The study serves as a proof-of-concept, demonstrating that different ML models can yield varying results when predicting CPSP. Among these, a prediction model based on Gradient Boosting exhibited the best fit. However, the potential risk of overfitting cannot be ruled out, necessitating further validation before clinical implementation.

Despite the minimally invasive nature of video-assisted thoracoscopic surgery (VATS), moderate-to-severe postoperative pain remains frequent and impairs recovery. Intravenous lidocaine possesses multimodal analgesic, antihyperalgesic and anti-inflammatory properties that may improve pain control and functional outcomes, but robust evidence in thoracic surgery is lacking. Moreover, its potential to attenuate neuropathic pain, a key component of chronic post-thoracic pain syndromes, has not been adequately investigated. This trial will determine whether continuous perioperative intravenous lidocaine infusion improves recovery, reduces acute pain intensity and prevents the development of neuropathic pain after VATS. This single-centre, randomised, double-blind, placebo-controlled trial will enrol 84 adult patients undergoing elective VATS. Participants will be randomised (1:1) to receive either intravenous lidocaine (bolus 1 mg/kg at induction followed by continuous infusion at 1.5 mg/kg/hour intraoperatively and postoperatively for 24 hours) or matched normal saline postoperatively, with identical intraoperative management in both groups. The primary outcome is the incidence of moderate-to-severe movement-evoked pain at 24 hours postoperatively. Secondary outcomes include pain at 48 and 72 hours, opioid consumption, pulmonary complications, sleep quality, quality of recovery, neurocognitive outcomes and chronic neuropathic pain at 3 months. Analyses will follow the intention-to-treat principle. The study protocol was approved by the Institutional Review Board of Tongji Hospital (Reference No. TJ-IRB202509102) and registered in the Chinese Clinical Trial Registry (ChiCTR2500111163). Written informed consent will be obtained from all participants. Results will be submitted to peer-reviewed journals and academic conferences. ChiCTR2500111163.

Hydatid disease, caused by various Echinococcus species, is endemic in developing countries and most commonly affects the liver and lungs. Approximately 7.4% of cases involve intrathoracic extrapulmonary locations, with pleural involvement usually resulting from rupture of adjacent hepatic or pulmonary cysts. However, primary pleural hydatid cysts are extremely rare, representing less than 1% of extrapulmonary cases, and may cause compressive symptoms depending on size and location. Diagnosis is guided by serologic testing and imaging, while surgical excision remains the mainstay of treatment. A 26-year-old Middle Eastern female presented to the emergency department with exertional dyspnea, right-sided pleuritic chest pain, low-grade fever, and night sweats. Physical examination revealed decreased breath sounds, dullness to percussion, and increased tactile fremitus on the right side, while imaging confirmed a moderate-to-large right pleural effusion with adhesions and fibrinous strands. Laboratory tests showed a lymphocytic exudative effusion with elevated adenosine deaminase, initially suggesting tuberculous pleuritis. However, negative cultures and positive anti-Echinococcus antibodies redirected the diagnosis to hydatid disease. Video-assisted thoracoscopic surgery (VATS) revealed dense adhesions and granulomatous inflammation on biopsy. Due to restricted lung expansion, right thoracotomy was performed, excising a cystic mass from the mediastinal pleura. Histopathology confirmed a hydatid cyst. The patient recovered well and was discharged on oral Albendazole. This case emphasizes the rarity of primary pleural hydatid cysts, the diagnostic challenges they pose, and the importance of considering parasitic infections in pleural effusions for timely surgical and medical management.

Analgesic efficacy of the subtransverse process interligamentary plane block in thoracic surgery: A randomized, controlled, non-inferiority trial.

Effect of the surgical day of the week on postoperative outcomes of video-assisted thoracoscopic surgery for early-stage lung cancer patients: A multicenter cohort study.

Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancers, and surgical resection is the gold-standard treatment for resectable disease. Minimally invasive surgery (MIS), which includes video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), has emerged as an alternative option to thoracotomy, with the aim of minimizing perioperative morbidity without compromising oncological efficacy. This narrative review evaluates long-term oncological outcomes (overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS)) in patients with NSCLC at different stages who underwent MIS. Retrospective and prospective studies, as well as meta-analyses, are included. VATS has shown comparable and, in many cases, superior oncological outcomes compared to open surgery, with more evident benefits in the early stages of the disease. Although mainly in retrospective studies, RATS has demonstrated efficacy in terms of oncological outcomes comparable to open surgery, even in advanced stages or complex resections. With regard to the direct comparison between VATS and RATS, the two MIS techniques have shown similar OS rates, albeit some prospective data and meta-analyses suggest a potential DFS advantage for RATS. MIS is a safe and effective surgical approach in terms of oncological outcomes for resectable NSCLC; nevertheless, it will be necessary to await the results of further randomized studies currently ongoing to better define the long-term benefits of each technique.

Catamenial pneumothorax (CP) is a rare cause of recurrent spontaneous pneumothorax in women of reproductive age, typically linked to endometriosis. It usually occurs 24 h before or within 72 h of the onset of menstruation, along with hormonal changes leading to lung collapse. This retrospective study analysed the data from 11 patients who underwent video-assisted thoracoscopic surgery (VATS) for CP at a tertiary care centre from March 2012 to December 2023. Pre-operative assessment included detailed history, physical examination, imaging and haematological investigations. Surgery was performed using a three-port VATS technique and involved resection of diaphragm (all 11 patients) along with diaphragmatic plication and wedge resection of the lung in 1 patient each. This was followed by talc pleurodesis in all the patients. Post-operative care included adequate pain relief, early mobilisation, active physiotherapy and monitoring air leaks. The mean patients' age was 18.9 years. Seven patients had pneumothorax within 24 h before menstruation and four within 72 h after. At surgery (VATS), diaphragmatic fenestrations were found in all the patients, with five having diaphragmatic endometriosis also. One patient had multiple blebs and another one exhibited visceral pleural endometriosis. The average surgery duration was 154 min, with minimal blood loss. All patients had uneventful recovery and no recurrences were observed during a median follow-up of 54 months. VATS is an effective, minimally invasive approach for the management of CP, with excellent surgical outcomes, shortened convalescence and no recurrence in our study.

BackgroundLung cancer is the leading cause of cancer-related mortality worldwide. With the widespread use of computed tomography (CT) screening, pulmonary ground-glass nodules are increasingly detected. Video-assisted thoracoscopic surgery (VATS) enables minimally invasive resection; however, the precise intraoperative localization of these non-palpable nodules remains challenging. The current commonly used preoperative CT-guided hook-wire localization, while effective, is associated with documented risks such as dislodgement (reported in up to ~10% of cases), pneumothorax requiring intervention, and rare but serious complications (e.g., air embolism). Thus, a safer and more reliable localization technique is desirable. Indocyanine green (ICG) fluorescence guidance has emerged as a promising alternative, though further validation in standardized cohorts is valuable. This study aimed to evaluate the feasibility and safety of ICG fluorescence localization and resection of pulmonary ground-glass nodules under near-infrared (NIR) fluorescence thoracoscopy.MethodsWe retrospectively analyzed the data of patients with pulmonary ground-glass nodules (peripheral type, diameter <2 cm) treated at the Department of Thoracic Surgery, The First Affiliated Hospital of Ningbo University from July 2022 to September 2022 and compared these data with a historical control group (n=23) who underwent CT-guided hook-wire localization between January and July 2015. Under CT guidance, we percutaneously injected diluted ICG (0.5–1 mL) near the target nodule, and the surgical team observed the fluorescence of the ICG by NIR thoracoscopy for localization and wedge resection.ResultsA total of 104 ground-glass nodules were identified from 94 patients who underwent resection by NIR thoracoscopic surgery. The median diameter of the nodules was 6 mm (range, 2–16 mm), and the median distance from the pleura was 9 mm (range, 2–28 mm). The median duration of the localization procedure was 15 min (range, 8–28 min). ICG fluorescence was clearly identified in 87 nodules [92.6%; 95% confidence interval (CI): 85.3–96.5%]. Minor complications occurred in 15 cases (16.0%; 95% CI: 9.9–24.5%) following puncture. The surgical margins were pathologically negative, and no further resection was required. According to postoperative pathology, there were 30 nodules (28.8%) of adenocarcinoma in situ, 53 (51.0%) of microinvasive adenocarcinoma, 6 (5.8%) of invasive adenocarcinoma, and 15 (14.4%) of benign nodules. Compared to the hook-wire control group, the ICG group exhibited a comparable overall procedural complication rate (16.0% vs. 26.1%, P=0.26). However, the ICG technique entirely eliminated the need for conversion to lobectomy due to localization device failure (0% vs. 8.7%, P=0.04), demonstrating superior reliability.ConclusionsCT-guided percutaneous injection of ICG combined with intraoperative NIR localization is a safe and feasible method for localizing pulmonary ground-glass nodules, demonstrating a high success rate in this cohort. This study supports the clinical utility of this technique as a practical alternative.

BackgroundLung cancer is among the most prevalent and lethal malignancies worldwide. Non-intubated video-assisted thoracoscopic surgery (VATS) has demonstrated advantages in reducing hospital length of stay (LOS). However, clinical practice indicates that a substantial proportion of patients still experience prolonged length of stay (PLOS). Currently, no risk prediction model exists specifically for PLOS following non-intubated VATS in lung cancer patients. This study aims to analyze clinical data to identify risk factors associated with PLOS and to develop a predictive model.MethodsA retrospective cohort study was conducted on patients undergoing non-intubated VATS lung cancer surgery between January 2024 and June 2025 at Shandong Provincial Hospital Affiliated to Shandong First Medical University. Data were collected via the Hospital Information System (HIS) and telephone follow-up electronic questionnaires. Categorical variables were analyzed using χ2 tests, and continuous variables were assessed with t-tests in univariate analyses. Variables with statistical significance in univariate analysis were entered into multivariable logistic regression to identify independent predictors and construct the prediction model. A nomogram was created for visualization. Model discrimination was assessed using the area under the receiver operating characteristic (ROC) curve, and calibration was evaluated with calibration plots.ResultsOf 742 patients analyzed, 216 had a prolonged LOS (≥8 days). PLOS was associated with significantly higher comorbidity burdens, more complex surgeries, and worse postoperative outcomes, including a greater complication rate (48.6% vs. 20.0%) than the normal LOS group (all P<0.001). Multivariable analysis identified older age [odds ratio (OR) =1.053], longer preoperative wait (OR =7.729), postoperative complications (OR =2.970), and chest tube drainage >200 mL as independent risk factors for PLOS, while body mass index (BMI) ≥30.0 kg/m2 was protective (OR =0.043). The resulting predictive nomogram demonstrated excellent discrimination with an area under the curve (AUC) of 0.943.ConclusionsThis prediction model shows robust accuracy in identifying lung cancer patients at high risk of PLOS after non-intubated VATS. It provides a theoretical basis for early identification and timely intervention by clinical staff.

BackgroundPreoperative characterization of solitary pulmonary nodules is critical yet challenging, as distinguishing early-stage neoplasms from benign lesions is essential to prevent unwarranted anatomical resections. The study aimed to analyze the impact of preoperative positron emission tomography-computed tomography (PET-CT) on the incidence of video-assisted thoracoscopic surgery (VATS) lobectomy for unsuspected benign disease, in patients without preoperative diagnosis.MethodsThe study included 864 patients, after VATS lobectomy, without the preoperative diagnosis, between January 1, 2014 and December 31, 2020, with 654 receiving preoperative PET-CT and 210 without it. The propensity score matching analysis was done, calculating the predicted probability using: age, sex, cardiovascular comorbidities, previous malignancy, chronic obstructive pulmonary disease (COPD), diabetes, and T category, obtaining equal groups of 210 patients with preoperative PET-CT (PET group) and without preoperative PET-CT (non-PET group). Univariate and multivariate analyses assessed the impact of the various factors on the incidence of benign postoperative diagnosis.ResultsNo significant difference was found in benign postoperative diagnosis between the PET and non-PET groups [n=6 (2.9%) vs. n=10 (4.8%), P=0.31; risk difference (RD): −0.019, 95% confidence interval (CI): −0.060 to 0.022] In the univariate analysis, younger age [60.75 vs. 65.5 years, P=0.02] and absence of COPD (4.6% vs. 0%, P=0.046), significantly influenced the risk of the postoperative unsuspected benign diagnosis. The younger age emerged as the sole significant risk factor for VATS lobectomy for benign lesions [P=0.042, odds ratio (OR) =1.062; 95% CI: 1.002–1.127].ConclusionsThe use of preoperative PET-CT did not decrease the risk of performing VATS lobectomy on unsuspected benign tumors. That risk should be considered when qualifying for VATS lobectomy, especially in younger patients.

Short-term outcomes of multi-arm uniportal robotic thoracic surgery versus uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer.

BackgroundTubeless anesthesia for non-intubated uniportal video-assisted thoracoscopic surgery (NI-UniVATS) has been widely used in various thoracic surgical procedures. However, most patients selected for this procedure have a normal body mass index (BMI), and the impact of this surgery on patients with high BMI (H-BMI) remains unclear. The study aims to evaluate the perioperative course of NI-UniVATS in H-BMI patients.MethodsA retrospective analysis was conducted on data from patients who underwent tubeless anesthesia for NI-UniVATS at The Affiliated Hospital of Hebei University between June 2023 and June 2025. A total of 414 eligible patients were included, with 38 in the H-BMI group (BMI ≥28 kg/m2) and 376 in the non-high BMI (NH-BMI) group (BMI <28 kg/m2). The intraoperative management and postoperative outcomes of the two groups were comprehensively compared.ResultsThe clinical characteristics of the two groups were comparable, including age (P=0.78), gender (P=0.81), and surgical type (P=0.84). The number of intraoperative anesthetic adjustments was significantly higher in the H-BMI group than in the NH-BMI group (1.39±1.36 vs. 0.29±0.57, P=1×10−5). Intraoperative complications such as coughing (2.63%, P=0.31), hypercapnia (5.26%, P=0.15), and airway management due to laryngeal mask displacement (2.63%, P=0.31) occurred only in the H‑BMI group. No significant differences were observed between the two groups in mediastinal movement (34.21% vs. 15.78%, P=0.06), hypoxemia (10.52% vs. 2.63%, P=0.16), or intraoperative bleeding (5.26% vs. 7.89%, P=0.64). There were no statistically significant differences between the H-BMI group and the NH-BMI group in terms of operation time (122.05±55.55 vs. 110.92±47.45 min, P=0.41), intraoperative blood loss (10.63±10.98 vs. 13.95±17.67 mL, P=0.14), extubation (12.18±18.2 vs. 9.0±7.02 min, P=0.50), and post-anesthetic care unit recovery (32.18±12.07 vs. 34.11±19.43 min, P=0.74). Regarding postoperative pulmonary complications, in the H-BMI group, there were 4 cases (10.86%) of pleural effusion, 3 cases (7.89%) of atelectasis, and 2 cases (5.26%) of pneumothorax; in the NH-BMI group, the corresponding numbers were 2 cases (5.26%), 2 cases (5.26%), and 3 cases (7.89%). There were no statistically significant differences in chest drainage (500.26±553.80 vs. 521.32±523.40 mL, P=0.70), chest tube duration (3.68±2.37 vs. 3.74±2.79 days, P=0.95), postoperative discharge (4.87±2.52 vs. 4.45±2.69 days, P=0.31), and total costs (expressed in US dollars) (5,605.84±1,421.34 vs. 5,350.37±1,511.90, P=0.23) between the two groups.ConclusionsCompared with NH-BMI patients, H-BMI patients undergoing NI-UniVATS have similar intraoperative conditions and postoperative outcomes, but require more intraoperative anesthetic adjustments.

Background: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique for lobectomy in non-small-cell lung cancer (NSCLC), offering advantages such as reduced complications and quicker recovery compared to open lobectomy. However, the long-term survival benefits of VATS relative to open lobectomy remain unclear, particularly in observational studies where treatment selection may introduce bias. Objectives: This retrospective study compared overall survival and secondary outcomes (e.g., length of hospital stay and complications) between VATS and open lobectomy among patients with early-stage NSCLC treated at Princess Margaret Hospital between 2002 and 2010. The study also attempted to address the gap in knowledge regarding the effectiveness of VATS when baseline characteristics differ between surgical methods. Methods: Propensity score matching (PSM) was used to balance baseline covariates between the VATS and open lobectomy groups. Kaplan-Meier survival analysis and Cox proportional hazards models were applied to evaluate overall survival. Linear regression and logistic regression models were employed to analyze the length of hospital stay and the incidence of complications, respectively. Results: After matching, there were no significant differences in overall survival between VATS and open lobectomy. VATS was associated with significantly shorter hospital stays (p-value ≤0.001) and a lower likelihood of complications (OR = 0.62, p-value = 0.05). Conclusions: VATS and open lobectomy had comparable survival outcomes in patients with early-stage NSCLC after balancing baseline characteristics. VATS was associated with reduced hospital stay and complications, supporting its use as a viable alternative to open lobectomy in appropriate patients. These results suggest that VATS may offer clinical advantages, potentially influencing surgical decision-making in the management of NSCLC.

BackgroundChest tube placement after pulmonary resection has been conventionally recommended, yet the associated patient discomfort can hinder postoperative recovery. In previous work, we demonstrated that catheter drainage is a safe alternative to conventional chest tube following wedge resection and provides superior pain relief. This study aims to evaluate whether a complete tubeless strategy offers further advantages compared to catheter drainage.MethodsWe conducted a retrospective cohort study and enrolled patients who underwent video-assisted thoracoscopic surgery (VATS) pulmonary wedge resection at our institution between September 2020 and November 2024. Participants were categorized into a catheter drainage group or a tubeless group based on the absence of postoperative thoracic drainage. Propensity score matching (PSM) was applied in a 1:1 ratio to balance baseline characteristics. Univariate analysis was then used to compare operative outcomes and perioperative complications between the matched groups.ResultsOf the 460 initially eligible patients, 133 matched pairs were generated after PSM. The tubeless group demonstrated a significantly shorter operative duration (57.00 vs. 80.00 min, P<0.001) and lower postoperative pain scores [Numerical Rating Scale (NRS): 0.00 vs. 2.00, P<0.001] than the catheter group. No significant differences were observed in the incidence of postoperative complications, rates of reintubation, or length of postoperative hospital stay.ConclusionsOmitting thoracic drainage entirely is a feasible and advantageous approach for a highly selected subset of patients undergoing pulmonary wedge resection. In this selected cohort, the tubeless strategy is associated with diminished postoperative pain and enhanced patient satisfaction, without increasing perioperative risks. The observed reduction in operative time is likely confounded by patient selection factors and should not be interpreted as a direct benefit of the technique. These findings support its consideration in patients intraoperatively assessed as low-risk; however, the observed benefits should be interpreted in the context of the stringent selection criteria applied, which may limit generalizability.

BackgroundPain management is an essential part of enhanced recovery after surgery, facilitating early return to mobility and improving respiratory mechanics. Acute pain management guidelines for patients undergoing video-assisted thoracoscopic surgery (VATS) procedures have been published recently. We assessed compliance of Canadian surgeons with those guidelines.MethodsA survey was distributed to all currently practicing Canadian thoracic surgeons through the Canadian Association of Thoracic Surgeons (CATS). The survey included questions about demographics, nerve block techniques, and other analgesics. Responses were scored as not, partially, or fully compliant with Procedure Specific Postoperative Pain Management (PROSPECT) guidelines for nerve blocks and other analgesics.ResultsThe response rate was 25% (53 surgeons of 213 CATS members). Most surgeons infiltrated the port sites (83%) and placed intercostal nerve blocks (81%). However, only 16 (30%) respondents complied with guidelines on analgesic nerve blocks and 11 (21%) on analgesic medications. Ten (19%) respondents use a thoracic epidural. None of the respondents were in full compliance with the guidelines.ConclusionsEpidural analgesia is still commonly used despite the recommendation against their use. Epidurals are not superior to other blocks in terms of effectiveness but have a higher rate of complications. Only 30% offered one of the recommended blocks. The presence of a dedicated block room was associated with offering recommended blocks and overall nerve block compliance. The current survey did not capture barriers to regional anesthesia, or knowledge of the guidelines. While there is improvement compared to a prior survey, there is low overall compliance with pain management guidelines.

Background: The comparative efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) for analgesia after video-assisted thoracoscopic surgery (VATS) remains ambiguous. Objectives: This study aimed to compare the analgesic efficacy of ESPB and SAPB after VATS. Methods: In this prospective, randomized, open-label, blinded-endpoint (PROBE) trial, forty patients undergoing VATS were randomized to receive preoperative ultrasound-guided ESPB (n = 20) or SAPB (n = 20) with 30 mL of 0.25% bupivacaine. Ultrasound imaging confirmed local anesthetic dispersion. The primary outcome was total meperidine consumption in the first 24 hours postoperatively. Secondary outcomes included intraoperative fentanyl consumption and postoperative pain scores (Numerical Rating Scale (NRS) and Visual Analog Scale (VAS)). Results: The ESPB group required significantly less intraoperative fentanyl (median 50 µg vs. 80 µg, P &lt; 0.001). Pain scores were significantly lower in the ESPB group at 2, 4, and 8 hours (NRS and VAS, all P &lt; 0.05). Total 24-hour meperidine consumption was significantly lower in the ESPB group (40 mg vs. 80 mg, P &lt; 0.001). No significant differences were observed in adverse events. Conclusions: Erector spinae plane block provided superior analgesia compared to SAPB in patients undergoing VATS, as evidenced by reduced opioid consumption and lower pain scores. These findings support ESPB as an effective regional analgesic technique in VATS patients, warranting validation in larger, blinded, multicenter trials.