Anaes · Thoracic anaesthesia
VATS lobectomy anaesthesia and postoperative analgesia
Also known as VATS analgesia · Thoracic epidural · Paravertebral block · Lobectomy anaesthesia · ERAS thoracic
Anaesthesia for VATS lobectomy with lung isolation, protective OLV, and multimodal analgesia comparing thoracic epidural, paravertebral, ESP and systemic opioid-sparing strategies.
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Red flags
- Protective OLV: tidal volume 4–6 mL/kg predicted body weight; reassess isolation fibreoptically.
- Thoracic epidural remains potent but carries hypotension and rare neuraxial risk — paravertebral is often preferred after VATS.
- Multimodal systemic analgesia is mandatory even with regional blocks.
- Chest drain pain and shoulder tip referred pain need specific plans.
- Early mobilisation and cough-effective analgesia reduce pulmonary complications.
Meet the patient
A 68-year-old ex-smoker with COPD, FEV1 around 60 percent predicted and no resting hypercapnia, is listed for a right lower lobectomy by VATS. He is on apixaban for atrial fibrillation, stopped yesterday. Two questions decide whether he goes home breathing freely or returns with pneumonia: how do you keep him oxygenating on one lung, and how do you keep him coughing afterwards?[3]
Hold those two questions and the whole topic slots into place — isolation and protective ventilation answer the first, regional plus multimodal analgesia answer the second.[3]
References7ShowHide
- [1]Wu Z et al. Paravertebral vs Epidural Anesthesia for Video-assisted Thoracoscopic Surgery: A Randomized Trial Ann Thorac Surg, 2023.PMID 37573993
- [2]Yeap YL et al. Randomized Prospective Study Evaluating Single-Injection Paravertebral Block, Paravertebral Catheter, and Thoracic Epidural Catheter for Postoperative Regional Analgesia After Video-Assisted Thoracoscopic Surgery J Cardiothorac Vasc Anesth, 2020.PMID 32144059
- [3]Brassard CL et al. Step-by-step clinical management of one-lung ventilation: continuing professional development Can J Anaesth, 2014.PMID 25389025
- [4]Feray S et al. PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia, 2022.PMID 34739134
- [5]Horlocker TT et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med, 2018.PMID 29561531
- [6]Neal JM et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017. Reg Anesth Pain Med, 2018.PMID 29356773
- [7]El Tahan MR et al. Impact of Lower Tidal Volumes During One-Lung Ventilation: A 2022 Update of the Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth, 2023.PMID 37225546