Comparison of ultrasound-guided intertransverse process block versus paravertebral block for postoperative quality of recovery in elderly patients undergoing minimally invasive thoracic surgery: protocol for a randomised controlled trial.

Abstract

Thoracic paravertebral block (PVB) is widely used for analgesia but carries risks such as pneumothorax and hypotension. Intertransverse process block (ITPB) is a newer alternative that may offer comparable analgesia with a potentially improved safety profile. However, few studies have compared the two from the patient's perspective, and none have assessed ultrasound-guided ITPB against PVB for postoperative recovery quality in elderly patients. This two-centre, double-blind, parallel-group, randomised controlled trial will enrol 152 elderly patients (age ≥65 years) undergoing video-assisted thoracoscopic surgery (VATS) at West China Hospital and Shangjin Branch of West China Hospital, Sichuan University in China. Participants will be randomly assigned in a 1:1 ratio to receive either ultrasound-guided ITPB (n=76) or PVB (n=76). The primary outcome is the Quality of Recovery-15 (QoR-15) score on postoperative day 1. Secondary outcomes will include (1) QoR-15 scores measured on postoperative days 2, 3, 7 and 30; (2) pain scores at rest and during movement assessed on postoperative days 1, 2 and 3 using the Numerical Rating Scale (NRS); (3) worst NRS resting pain score within 30 min of post-anaesthesia care unit (PACU) admission; (4) proportion of patients requiring rescue analgesia within 24 hours after surgery; (5) patient satisfaction with analgesia within 24 hours after surgery; (6) total opioid consumption within 24 hours after surgery; (7) incidence of major complications of surgery within 7 days after surgery; (8) length of postoperative hospital stay; and (9) number of days at home within 30 days after surgery. The study protocol has received approval from the Ethics Committee of West China Hospital, Sichuan University (approval no. 2603), and the Ethics Committee of Shangjin Branch of West China Hospital, Sichuan University (approval no. 2613). Written informed consent will be obtained from all participants. Study results will be disseminated through publication in peer-reviewed journals. ChiCTR2600116524.