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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.

Last updated: Jul 16, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Ultrasound-Guided Cervical Vagus Nerve Block for Postoperative Opioid Consumption After Thoracoscopic Lung Surgery: Study Protocol for a Randomized Controlled Trial.

observational

Liang J, Yan X, Liang C, Chen S, Wei C, Wu A · Journal of pain research (2026)

Participants: N/A
Duration: 24 hours (primary outcome)
Intervention: 5 mL of 0.375% ropivacaine for ultrasound-guided cervical vagus nerve block (CVNB) added to standard thoracic paravertebral block (TPVB)
Outcome: Cumulative opioid consumption within 24 hours postoperatively (intravenous morphine milligram equivalents, MME); secondary outcomes include pain scores, time to first rescue analgesia, nausea/vomiting incidence, quality of recovery, and sleep quality
Effect Size: N/A (study protocol; results not yet reported)
Population: Adult patients (≥18 years) scheduled for elective video-assisted thoracoscopic surgery (VATS) lung resection

Result:

PubMed: 42445933DOI: 10.2147/JPR.S617955

Mechanism Graph

Vagus nerve transmits visceral nociception from lungs and pleura during thoracoscopic surgery
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Standard thoracic paravertebral block primarily targets somatic pain, insufficiently addressing visceral pain
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Cervical vagus nerve block with local anesthetic attenuates vagally mediated visceral pain signals
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Reduced visceral pain leads to lower postoperative opioid consumption

Limitations

  • ⚠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.

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References

  1. 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
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.