Do we need complementary locoregional analgesia in patients undergoing minimally invasive thoracic surgical procedures?

Pain control after minimally invasive thoracic surgery is a contemporary question, which still raises passionate debates. The study published by Ghee and colleagues (1) evaluated continuous subpleural bupivacaine in a prospective randomized trial and concluded to no benefit. Eighty-six patients admitted for VATS lobectomy or wedge resection were randomly assigned either to continuous subpleural bupivacaine or to intraoperative incision site injection, associated with standard oral or intravenous painkillers as per request. Post-operative consumption of narcotics, acetaminophen or non-steroidal anti-inflammatory drugs was similar in both groups in a linear mixed model analysis. Self-reported usage of non-steroidal anti-inflammatory drugs was higher on post-operative days 4, 5, 6 and 7 in the subpleural infusion group, while daily pain scores were similar. Length of hospital stay and 30-day pain scores were comparable