Paravertebral Block and Perioperative Ketamine in an Opioid-Sparing Analgesia Approach in Thoracic Surgery: A Retrospective Single-Centre Study

Background: Regional anaesthesia techniques allow postoperative pain control while reducing opioid con-sumption. Ketamine is another viable option for minimising perioperative opioid use. We evaluated the ef-ficacy of a perioperative multimodal analgesia protocol incorporating paravertebral block (PVB) and keta-mine infusion in patients undergoing video-assisted thoracic surgery (VATS). Methods: This retrospective single-centre study divided patients into two groups: the opioid-sparing (OS) group receiving PVB and ketamine (n = 41), and the control group (n = 21) treated with postoperative morphine infusion. The primary outcome was the need for rescue opioid therapy; secondary outcomes in-cluded postoperative pain scores assessed at multiple time points over 48 hours using the Numeric Rating Scale (NRS), prevalence of chronic postoperative pain at three months, perioperative haemodynamics, and hospital length of stay. Results: Rescue opioid administration was significantly lower in the OS group (19.5% vs. 47.6%, p = 0.021). Upon awakening, pain control was lower in the OS group (1 [1–2] vs 4 [3–4], p < 0.001); however, pain scores did not differ afterwards. Chronic postoperative pain was less common in the OS group (n = 10/41; 23.8% vs n = 11/21, 52.4%; p = 0.028). No differences in haemodynamics were reported, nor were there any ketamine/PVB-related complications. No difference in length of hospital stay was observed between the groups. Ketamine starting dose and postoperative morphine requirements were inversely correlated (rho = -0.380; p = 0.002). Conclusion: A multimodal analgesia protocol integrating PVB and ketamine infusion in patients undergoing VATS may effectively reduce postoperative opioid consumption, improving analgesia in the initial postop-erative period.