Objective: To evaluate the effectiveness, safety, and cost-effectiveness of three analgesic regimens-PCIA (patient-controlled intravenous analgesia), R (ropivacaine), and LB (liposomal bupivacaine) local infiltration-in adult patients undergoing VATS (video-assisted thoracoscopic surgery). Methods: Adults undergoing unilateral VATS in 2024 were retrospectively assigned to PCIA, R, and LB groups. IPTW (inverse probability of treatment weighting) balanced baseline confounders. The primary effectiveness outcome was the 72-h cumulative pain burden (area under the curve, AUC). Secondary outcomes included NRS (numerical rating scale) scores and early recovery indicators; independent factors for postoperative pain were also analyzed. Safety was assessed by adverse event incidences. CEA (cost-effectiveness analysis) was conducted from the Chinese healthcare perspective, with robustness validated by one-way and probabilistic sensitivity analyses (OWSA, PSA). Results: 829 patients (PCIA: 274; R: 258; LB: 297) were included. After IPTW, baseline characteristics were balanced (SMD < 0.1). The LB group had the lowest 72-h AUC and overall NRS score compared to PCIA (beta =- 11.01, P = 0.017; 0.80, 95% CI: 0.70- 0.89, P = 0.022) and R (beta = - 30.19, P < 0.001; 1.07, 95% CI: 0.96- 1.18, P < 0.001). LB group had the shortest time to first ambulation, and both LB and PCIA groups had shorter hospital stays than the R group (all P < 0.05). No significant differences were found in rescue analgesia incidence or consumption (P > 0.05). Advanced age and tumor history protected against postoperative pain, whereas alcohol history was a risk factor. No significant differences were found in adverse event rates, including postoperative nausea and vomiting, among the groups (all P > 0.05). Economically, PCIA had the highest total cost and R the lowest. LB was dominant over PCIA; versus R, the ICER (incremental cost-effectiveness ratio) for LB was USD 123.29 per 1-point NRS reduction. Sensitivity analyses confirmed robustness. Conclusion: For VATS postoperative analgesia, LB is associated with favorable analgesia and earlier recovery. It may be cost-effective, depending on acceptable WTP thresholds. PCIA and R remain safe and viable alternatives. These findings warrant further validation in large-scale prospective studies.
Background: Ipsilateral shoulder pain (ISP) after video-assisted thoracoscopic (VATS) surgery is common, distinct from incisional pain, and frequently overlooked in clinical practice. Transcutaneous electrical acupoint stimulation (TEAS) is a non-invasive, safe non-pharmacological analgesic modality. This trial protocol aims to evaluate the potential preventive effect of TEAS on ISP after VATS surgery. Patients and Methods: We will conduct a multicenter, single-blind randomized trial of 216 patients undergoing unilateral VATS surgery. Patients will be randomized 1:1 to receive either TEAS or sham stimulation. The TEAS group will receive two 30-minute sessions at acupoints Hegu (LI4), Neiguan (PC6), Jianliao (SJ14), and Jianyu (LI15) on the evening before surgery and before anesthesia induction on the day of surgery. The sham stimulation group will receive sensory-matched sham stimulation. The primary outcome is the incidence of ISP during shoulder movement at 24 hours postoperatively. Pain intensity will be assessed using the verbal rating scale (VRS), and ISP is defined as a VRS score >= 1. Secondary outcomes are cumulative opioid consumption within 24 hours postoperatively and postoperative nausea and vomiting at 24 hours. Other outcomes include shoulder pain during movement and at rest at 48 and 72 hours, opioid consumption at other time intervals, postoperative quality of recovery assessed with the 15-item Quality of Recovery scale (QoR-15), time to first flatus, and nausea and vomiting at different time points. Discussion: We hypothesize that TEAS reduces ISP incidence, opioid consumption, and improves postoperative recovery after VATS surgery. The findings of this trial will provide further evidence-based support for the prevention and management of perioperative ISP after VATS surgery, as well as a reference for the clinical application of non-pharmacological analgesic strategies. Trial Registration: ClinicalTrials.gov, NCT07494591.
