Adding cervical vagus nerve block to thoracic paravertebral block reduces postoperative opioid consumption after thoracoscopic lung surgery
This randomized, double-blind, placebo-controlled trial will test whether adding an ultrasound-guided cervical vagus nerve block (CVNB) with 5 mL of 0.375% ropivacaine to standard thoracic paravertebral block (TPVB) reduces cumulative opioid consumption within 24 hours postoperatively in patients undergoing video-assisted thoracoscopic surgery (VATS) lung resection. The primary outcome is cumulative opioid consumption expressed as intravenous morphine milligram equivalents (MME). The study aims to enroll 110 adult patients to detect a clinically meaningful reduction in opioid use.
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Adding cervical vagus nerve block to thoracic paravertebral block reduces postoperative opioid consumption after thoracoscopic lung surgery The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
Adding cervical vagus nerve block to thoracic paravertebral block reduces postoperative opioid consumption after thoracoscopic lung surgery
This conclusion is most relevant to: Adult patients (≥18 years) scheduled for elective video-assisted thoracoscopic surgery (VATS) lung resection.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Ultrasound-Guided Cervical Vagus Nerve Block for Postoperative Opioid Consumption After Thoracoscopic Lung Surgery: Study Protocol for a Randomized Controlled Trial. (Journal of pain research, 2026) —
How It Works
The proposed biological pathway:
- ▸Vagus nerve transmits visceral nociception from lungs and pleura during thoracoscopic surgery
- ▸Standard thoracic paravertebral block primarily targets somatic pain, insufficiently addressing visceral pain
- ▸Cervical vagus nerve block with local anesthetic attenuates vagally mediated visceral pain signals
- ▸Reduced visceral pain leads to lower postoperative opioid consumption
Who Might Benefit
Evidence fit by population:
- ▸Adult patients (≥18 years) scheduled for elective video-assisted thoracoscopic surgery (VATS) lung resection
Recommended Dose
5 mL of 0.375% ropivacaine
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Study protocol only; no results yet available to confirm efficacy or safety
- ▸Potential risk of respiratory or cardiovascular adverse effects from cervical vagus nerve block, which will be assessed but not yet known
- ▸Single-center design may limit generalizability
Frequently Asked Questions
What is cervical vagus nerve block (CVNB)?▼
CVNB is an ultrasound-guided regional anesthesia technique that involves injecting a local anesthetic (e.g., ropivacaine) around the vagus nerve in the neck to block visceral pain signals from the lungs and pleura during thoracoscopic surgery.
Why is CVNB being studied for thoracoscopic lung surgery?▼
Standard regional techniques like thoracic paravertebral block mainly target somatic pain but do not fully address visceral pain transmitted via the vagus nerve. CVNB may provide more complete analgesia and reduce the need for opioids.
What is the primary outcome of this trial?▼
The primary outcome is cumulative opioid consumption within 24 hours after surgery, measured in intravenous morphine milligram equivalents (MME).
How many patients will be enrolled in this study?▼
A total of 110 adult patients undergoing elective video-assisted thoracoscopic surgery (VATS) lung resection will be enrolled.
References
- 1.Liang J, Yan X, Liang C, Chen S, Wei C, Wu A. “Ultrasound-Guided Cervical Vagus Nerve Block for Postoperative Opioid Consumption After Thoracoscopic Lung Surgery: Study Protocol for a Randomized Controlled Trial..” Journal of pain research, 2026. PMID: 42445933 DOI: 10.2147/JPR.S617955