Coppens S, Hoogma DF, Dewinter G, et al.
Anesthesiology (June 19, 2025).
doi:10.1097/ALN.0000000000005625
In this multicenter, double-blind, randomized trial involving 100 patients undergoing uniportal video-assisted thoracoscopic surgery, intercostal nerve blocks administered under direct surgical vision significantly reduced opioid consumption compared to ultrasound-guided erector spinae plane (ESP) blocks. At 12 hours post-extubation, morphine usage was lower in the intercostal group (10.9 mg vs. 17.6 mg, p=0.0015), with sustained benefit at 24 hours (18.7 mg vs. 26.7 mg, p=0.018). The intercostal group also experienced less early postoperative pain and required less rescue analgesia. No differences were seen in complication rates, patient satisfaction, or length of stay, but ESP blocks showed higher systemic absorption of local anesthetics. These findings support the intercostal block as an effective and safe analgesic technique for thoracic procedures when performed under direct vision.
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