Combined non-intubated anaesthesia and paravertebral nerve block in comparison with intubated anaesthesia in children undergoing video-assisted thoracic surgery.

Wei, Wei; Fan, Yanting; Liu, Wei; Zhao, Tianyun; Tian, Hang; Xu, Yingyi; Tan, Yonghong; Song, Xingrong; Ma, Daqing

BACKGROUND This study is to investigate if non-intubated anaesthesia combined with paravertebral nerve block (PVNB) can enhance recovery in children undergoing video-assisted thoracic surgery (VATS). METHODS A randomized controlled trial including 60 patients aged 3 to 8 years old who underwent elective VATS was performed. They were randomly assigned to receive non-intubated anaesthesia combined with PVNB or general anaesthesia with tracheal intubation (1:1 ratio). The primary outcome was the length of postoperative in-hospital stay. The secondary outcomes included emergence time, the incidence of emergence delirium, time to first feeding, time to first out-of-bed activity, pain score and in-hospital complications. RESULTS The non-intubated group had shorter postoperative in-hospital stay than the control group (4 days [IQR, 4 - 6] vs 5 days [IQR, 5 - 8], 95% CI 0 - 2; P = 0.013). When compared to the control group, the incidence of emergence delirium (odds ratio [OR] 3.39, 95% CI 1.01 - 11.41; P = 0.043), emergence time, duration in the PACU, time to first eating food, first out-of-bed activity, pain score and consumption of sufentanil (at 6 and 12 hours after surgery) were decreased in the intervention group. In contrast, the incidence of airway complications was higher in the control than the intervention group (27.6% vs. 6.9%, P = 0.037). There was no statistical significance in the occurrence of PONV, pneumothorax and other complications between two groups. CONCLUSIONS Non-intubated anaesthesia combined with PVNB enhances recovery in paediatric patients for video-assisted thoracic surgery although further multi-centre study is needed.