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Purpose <p>This study aimed to evaluate the effects of different tubeless anesthesia strategies on postoperative recovery in patients undergoing video-assisted thoracoscopic (VATS) wedge resection within an enhanced recovery after surgery (ERAS) protocol.</p> Methods <p>In this prospective randomized controlled trial, 120 patients scheduled for elective VATS wedge resection were randomly assigned to one of three groups: double-lumen endotracheal tube intubation (DLETT), laryngeal mask airway combined with intercostal nerve block (LMA + INB), or laryngeal mask airway combined with paravertebral block (LMA + PVB). Primary outcomes included length of hospital stay, time to ambulation and oral intake, and visual analog scale (VAS) pain scores. Secondary outcomes included intraoperative hemodynamics, arterial blood gas analysis, serum inflammatory cytokines (IL-6, IL-1β, TNF-α), postoperative complications, and total hospitalization costs.</p> Results <p>Patients in the LMA + PVB group had significantly shorter hospital stays and earlier ambulation compared to the DLETT group (<i>p</i> &lt; 0.001). VAS pain scores at rest and during coughing were consistently lower in the LMA + PVB group from 6 to 24&#xa0;h postoperatively (<i>p</i> &lt; 0.01). Heart rate, mean arterial pressure, and oxygenation parameters—including peripheral capillary oxygen saturation (SpO₂), partial pressure of arterial oxygen (PaO₂), and arterial oxygen saturation (SaO₂)—remained within physiological ranges in all groups throughout the perioperative period. IL-6 and IL-1β levels at 24&#xa0;h were significantly lower in the LMA groups (<i>p</i> &lt; 0.01). While DLETT provided better surgical field visibility, it was associated with higher rates of sore throat and hoarseness, as well as greater hospitalization costs.</p> Conclusion <p>Tubeless anesthesia, particularly LMA + PVB, enhances postoperative recovery following VATS wedge resection by reducing pain, inflammation, and hospitalization duration. These findings suggest that LMA + PVB may be a feasible alternative to conventional intubation-based anesthesia in selected clinical settings.</p> Clinical trial registration <p>This study was registered at the Chinese Clinical Trial Registry (ChiCTR2300073484) on July 12, 2023.</p>

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Tubeless anesthesia improves postoperative recovery following VATS wedge resection: a prospective randomized controlled study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月16日

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  • Xiaoling Li,
  • Shaohua Guo,
  • Weidong Liang,
  • Rui Han,
  • Yi Wang,
  • Maolin Zhong,
  • Liuqing Yuan

摘要

Purpose

This study aimed to evaluate the effects of different tubeless anesthesia strategies on postoperative recovery in patients undergoing video-assisted thoracoscopic (VATS) wedge resection within an enhanced recovery after surgery (ERAS) protocol.

Methods

In this prospective randomized controlled trial, 120 patients scheduled for elective VATS wedge resection were randomly assigned to one of three groups: double-lumen endotracheal tube intubation (DLETT), laryngeal mask airway combined with intercostal nerve block (LMA + INB), or laryngeal mask airway combined with paravertebral block (LMA + PVB). Primary outcomes included length of hospital stay, time to ambulation and oral intake, and visual analog scale (VAS) pain scores. Secondary outcomes included intraoperative hemodynamics, arterial blood gas analysis, serum inflammatory cytokines (IL-6, IL-1β, TNF-α), postoperative complications, and total hospitalization costs.

Results

Patients in the LMA + PVB group had significantly shorter hospital stays and earlier ambulation compared to the DLETT group (p < 0.001). VAS pain scores at rest and during coughing were consistently lower in the LMA + PVB group from 6 to 24 h postoperatively (p < 0.01). Heart rate, mean arterial pressure, and oxygenation parameters—including peripheral capillary oxygen saturation (SpO₂), partial pressure of arterial oxygen (PaO₂), and arterial oxygen saturation (SaO₂)—remained within physiological ranges in all groups throughout the perioperative period. IL-6 and IL-1β levels at 24 h were significantly lower in the LMA groups (p < 0.01). While DLETT provided better surgical field visibility, it was associated with higher rates of sore throat and hoarseness, as well as greater hospitalization costs.

Conclusion

Tubeless anesthesia, particularly LMA + PVB, enhances postoperative recovery following VATS wedge resection by reducing pain, inflammation, and hospitalization duration. These findings suggest that LMA + PVB may be a feasible alternative to conventional intubation-based anesthesia in selected clinical settings.

Clinical trial registration

This study was registered at the Chinese Clinical Trial Registry (ChiCTR2300073484) on July 12, 2023.