Comparison Effects of Erector Spinae Plan Block(ESP), Paravertebral Block(PVB) and Mid-point Transverse Process to Pleura Block(MTP) on Perioperative Pain Measured With Analgesia Nociceptive Index Monitor on Video-assisted Thoracoscopic Surgey(VATS)

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive thoracic surgery procedure performed with the help of a retractor-free camera through small skin incisions used to diagnose and treat chest diseases. Many of the major procedures traditionally performed with open thoracoscopic surgery can be performed using smaller sections with video assistance.

Thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections.

An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting.

Local anaesthetic techniques essential for nonentubeted video assisted thoracic surgery include thoracic epidural anaesthesia, cervical epidural anaesthesia, paravertebral block, intercostal nerve block, injection of local anaesthetic at the site of trocar incision local vagus blockade, erector spinae plane block, serratus anterior plane block and pectoralis nerve block.

Thoracic epidural analgesia, once considered the gold standard for thoracotomy; due to the risks of complications related to dural puncture, epidural hematoma, neuropathy and hypotension, it is no longer the first choice for VATS and has been replaced by peripheral blocks.