In a prospective, double-blind, randomized controlled trial conducted at a leading medical center, Yin Zhou and other investigators have discovered a novel approach to enhance postoperative pain control for patients undergoing video-assisted thoracoscopic surgery (VATS). The combination of Paracetamol and Mannitol injection with thoracic paravertebral block (TPVB) appears to offer significant benefits in acute pain management and may contribute to a diminished need for opioids in patients undergoing VATS.

The study focused on the effectiveness of a combination therapy involving Paracetamol and Mannitol injection, coupled with TPVB in post-VATS pain. Those scheduled for VATS were randomized to three groups: General anesthesia group (Group C), TPVB group (Group T), and TPVB combined with Paracetamol and Mannitol injection group (Group TP). The key endpoint was visual analog scale (VAS) scores estimated at rest and during coughing.

Secondary endpoints encompassed the occurrence of adverse events, time to first use of an analgesic pump, total use of Oxycodone in the analgesic pump, urine volume, number of efficient and total analgesic pump compressions in the first 48 hours postoperatively, perioperative Sufentanil use, time to extubation, and length of hospitalization.

Key Findings:

• Significant Pain Reduction: Patients in the group receiving the combined treatment (TPVB + Paracetamol and Mannitol injection) reported markedly lower VAS pain scores at 1, 12, 24, and 48 postoperative hours, both at rest and during coughing, compared to the other two groups (Table 1).

• Reduced Opioid Consumption: The study demonstrated a substantial drop in intraoperative Sufentanil and postoperative Oxycodone consumption in Group TP. This not only highlighted the efficacy of the novel approach but also addressed concerns related to opioid overuse.
• Enhanced Recovery Parameters: Patients in Group TP experienced a shorter time to the first use of the analgesic pump, as well as a lower total consumption of Oxycodone in the analgesic pump. Additionally, the number of efficient and total compressions of patient-controlled analgesia was considerably reduced in this group when compared to Group C and Group T.
• Safe and Well-Tolerated: Importantly, the study found no profound differences in terms of adverse effects, extubation time, and length of hospital stay among the three groups. This suggests that the combination of Paracetamol and Mannitol injection with TPVB is not only efficient but also safe and well-tolerated by the affected people.
• Optimized Urine Output: Patients in the combined treatment group exhibited higher urine output, indicating potential positive effects on overall renal function.

This research has meaningful implications for the field of thoracic surgery and postoperative pain management. The novel approach involving Paracetamol and Mannitol injection plus TPVB has the potential to revolutionize acute pain control and diminish opioid consumption during VATS.