Ultrasound-Guided Thoracic Paravertebral Block with Levobupivacaine-Esketamine Combination for Thoracoscopic Lung Cancer Surgery

Objective : This retrospective cohort study evaluated the efficacy of esketamine combined with levobupivacaine in ultrasound-guided thoracic paravertebral block (TPVB) for improving opioid-sparing analgesia and enhancing recovery after thoracoscopic lung cancer surgery. Methods : Patients undergoing thoracoscopic radical resection of non-small cell lung cancer (NSCLC) between 2020–2024 were stratified into two groups: the intervention group received TPVB with 0.375% levobupivacaine plus esketamine (0.5 mg/kg), while the control group received levobupivacaine alone. Primary outcomes included cumulative sufentanil consumption and resting/movement-associated pain scores (VAS, 0–10) within 48 hours postoperatively. Secondary outcomes encompassed time to first ambulation, chest tube duration, hospital stay, and safety profiles. Results : Among 216 patients (108 per group), the intervention group demonstrated a 32% reduction in 48-hour sufentanil consumption (53.5 ± 10.2 μg vs. 78.6 ± 12.4 μg, P < 0.001) and significantly lower VAS scores at rest (1.6 ± 0.5 vs. 2.7 ± 0.6, P < 0.001) and during movement (2.4 ± 0.6 vs. 4.0 ± 0.9, P < 0.001) at 48 hours. Recovery metrics improved markedly, with shorter time to first ambulation (12.6 ± 2.8 h vs. 18.4 ± 3.2 h, P < 0.001), reduced chest tube retention (2.9 ± 0.7 vs. 4.1 ± 1.0 days, P < 0.001), and decreased hospital stay (5.1 ± 1.0 vs. 6.5 ± 1.2 days, P = 0.002). Transient hallucinations occurred more frequently in the intervention group (8.3% vs. 0%, P = 0.006), with no severe adverse events. Conclusion : Esketamine-levobupivacaine TPVB significantly reduces postoperative opioid requirements, enhances analgesia, and accelerates functional recovery in thoracoscopic lung cancer surgery. This multimodal approach aligns with ERAS protocols while advocating for opioid stewardship, though dose optimization may further improve safety. ChiCTR2400093803