Thoracic paravertebral block remains the preferred regional analgesic technique for video-assisted thoracoscopic surgery, according to a new randomized non-inferiority trial. While intrathecal morphine provided comparable pain scores and recovery quality, it failed to demonstrate non-inferiority for reducing postoperative opioid consumption, reinforcing current guideline recommendations.  Video-assisted thoracoscopic surgery still presents a significant pain management challenge Video-assisted thoracoscopic surgery (VATS) has transformed thoracic surgery by reducing tissue trauma, shortening hospital stays, and accelerating postoperative recovery compared with open thoracotomy. Nevertheless, postoperative pain remains a major clinical concern. Moderate-to-severe pain affects nearly two-thirds of patients undergoing VATS. Poorly controlled pain impairs coughing, deep breathing, sputum clearance, and early mobilization while increasing the risk of pulmonary complications and chronic postsurgical pain. Modern Enhanced Recovery After Surgery (ERAS) pathways emphasize multimodal analgesia, combining systemic medications with regional anesthesia techniques to minimize opioid exposure while maintaining excellent pain control. Among available regional techniques, thoracic paravertebral block (TPVB) is widely recommended. However, intrathecal morphine (ITM) offers several practical advantages, including technical simplicity, single-shot administration, and broad availability in hospitals where ultrasound-guided regional anesthesia expertise may be limited. Until now, robust head-to-head evidence comparing these two strategies has been limited. New randomized trial compares two commonly used analgesic techniques Researchers conducted a prospective randomized observer-blinded non-inferiority trial evaluating postoperative analgesia after elective VATS. Study design The investigators enrolled: 72 adult patients undergoing elective VATS ASA physical status I–III Randomized 1:1 36 patients received thoracic paravertebral block 36 patients received intrathecal morphine Two patients converted from VATS to thoracotomy and were excluded from the per-protocol analysis. Regional anesthesia protocols Thoracic paravertebral block Ultrasound-guided T5 level 0.25% bupivacaine Epinephrine added Intrathecal morphine Lumbar spinal injection Morphine dose: 5 μg/kg Based on ideal body weight All patients received identical general anesthesia, multimodal postoperative analgesia, and morphine patient-controlled analgesia (PCA). Primary outcome […]

Introduction Traumatic rib fractures remain a significant cause of morbidity and mortality, particularly in older adults and polytrauma patients. Pain from rib fractures leads to impaired respiratory mechanics, reduced tidal volumes, and ineffective coughing, all of which predispose patients to complications such as atelectasis, pneumonia, and respiratory failure. Importantly, the use of systemic opioids—long considered the mainstay of analgesia—can further exacerbate respiratory depression, creating a challenging clinical paradox. Thoracic epidural analgesia (TEA) has traditionally been regarded as the gold standard for pain control in patients with multiple rib fractures. However, TEA is not feasible in many trauma patients due to contraindications such as coagulopathy, spinal injuries, altered mental status, or hemodynamic instability. This gap in care has driven interest in alternative regional anesthesia techniques. In recent years, thoracic fascial plane blocks—including erector spinae plane (ESP) block and serratus anterior plane block (SAPB)—have emerged as promising options. These techniques are technically simpler, safer in anticoagulated patients, and can be performed in a wider range of clinical settings. The scoping review by Niazi et al. provides a comprehensive evaluation of the current evidence supporting the use of these blocks in traumatic rib fractures. Study objective and methods The primary aim of this scoping review was to evaluate the effectiveness of thoracic fascial plane blocks in patients with multiple rib fractures, focusing on: Pain control Opioid consumption Respiratory function Secondary objectives included assessing safety and comparing these techniques with traditional modalities such as TEA and paravertebral blocks (PVB). Key methodological features Comprehensive database search: PubMed Embase Cochrane databases Web of Science Scopus Google Scholar ClinicalTrials.gov Timeframe: From database inception to October 2023 Inclusion criteria: Patients with unilateral or bilateral rib fractures Use of fascial plane blocks (ESP, SAPB, PEC, etc.) Reporting of pain or opioid outcomes Study types included: Randomized controlled trials (RCTs) […]