• Xin-Qi Cheng, Mao-Yun Zhang, Qi Fang, De-Wen Shi, Xiao-Ci Huang, Xue-Sheng Liu, Er-Wei Gu, and Guang-Hong Xu.
• From the Department of Anaesthesiology, First Affiliated Hospital, Anhui Medical University and Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China.
• Eur J Anaesthesiol. 2021 Sep 9.

BackgroundPeripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect.ObjectiveThis prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy.DesignThis was a randomised controlled study.SettingThe First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020.PatientsFifty patients scheduled for single-port thoracoscopic lobectomy were enrolled.InterventionPatients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg-1 remifentanil, it was then infused at 0.2 to 0.5 μg kg-1 min-1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values.Main Outcome MeasuresThe primary outcome was intra-operative remifentanil consumption.ResultsMedian [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03).ConclusionWe have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects.Trial Registrationhttp://www.chictr.org.cn, ChiCTR2000029337.Copyright © 2021 European Society of Anaesthesiology.

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