Comparison of thoracic epidural and peripheral regional analgesia techniques for postoperative pain management in video-assisted thoracoscopic surgery (VATS) procedures: a retrospective study

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Abstract
Aims: Effective postoperative analgesia is essential in thoracic surgery to preserve respiratory function, facilitate early mobilization, and reduce pulmonary complications. Thoracic epidural analgesia (TEA) has traditionally been regarded as the gold standard for pain control. However, the increasing use of minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) has prompted the adoption of ultrasound-guided peripheral regional anesthesia techniques, including the paravertebral block (PVB), erector spinae plane block (ESPB), and serratus anterior plane block (SAPB). This study aimed to compare TEA and peripheral regional blocks in terms of postoperative pain scores, opioid consumption, and recovery parameters in patients undergoing VATS procedures. Methods: This retrospective study included patients who underwent elective VATS between January 2023 and January 2025. Based on the analgesic technique received, patients were divided into two groups: TEA (n=82) and peripheral block group (PER, n=65). Pain was assessed using the Visual Analog Scale (VAS) at the post-anesthesia care unit (PACU) and at 24, 48, and 72 hours postoperatively. Opioid doses were standardized to morphine milligram equivalents (MME). Additional outcomes included intraoperative opioid use, postoperative rescue analgesia, length of hospital stay (LOS), complication rates, and 90-day mortality. Results: Patients in the TEA group had significantly lower VAS scores at all time points compared to the PER group (p

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