
==== Front
Pain Ther
Pain Ther
Pain and Therapy
2193-8237
2193-651X
Springer Healthcare Cheshire

39017777
638
10.1007/s40122-024-00638-x
Letter
A Response to: Letter to the Editor Regarding “Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial”
Xu Xia 1
Xie Ying-xin 1
Zhang Meng 1
Du Jian-hui 1
He Jin-xian 2
http://orcid.org/0000-0001-5138-3660
Hu Li-hong hlh_2000@163.com

1
1 https://ror.org/03et85d35 grid.203507.3 0000 0000 8950 5267 Department of Anesthesiology, The affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040 China
2 https://ror.org/03et85d35 grid.203507.3 0000 0000 8950 5267 Department of Thoracic Surgery, The affiliated Lihuili Hospital of Ningbo University, Ningbo, China
17 7 2024
17 7 2024
10 2024
13 5 13191321
15 6 2024
9 7 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
http://dx.doi.org/10.13039/501100017531 Medical and Health Research Project of Zhejiang Province 2023KY1036 Hu Li-hong issue-copyright-statement© Springer Healthcare Ltd., part of Springer Nature 2024
==== Body
pmcDear Editor,

We thank Professor Xue for his kind comments on our recently published article “Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial” [1]. They raised several questions of great significance to our research. So we hope to help readers better understand our research through this reply.

First of all, we must admit that the concern highlighted by Prof. Xue is reasonable. Prof. Xue mentioned that we did not clearly describe whether the experience of the anesthesiologist and surgeon performing the thoracic paravertebral block (TPB) was comparable. He was concerned that an unbalanced level of experience would have biased the primary outcomes in favor of the thoracoscopy-guided technique. It is true that we did not mention whether the doctors who performed TPB were skilled or experienced. However, we mentioned at the end of Sect. “Study Design and Population” that the surgery and anesthesia procedures were performed by the same experienced team. The team has worked together perfectly for more than 10 years. Thoracic surgery and thoracoscopy-guided thoracic paravertebral block (TTPB) were performed by Dr. He. Our team combined the technical principle of thoracoscopic-guided intercostal nerve block [2] and the principle of ultrasound-guided thoracic paravertebral block (UTPB), designed and confirmed the safety and effectiveness of TTPB technology [3, 4]. Dr. He has rich experience in the TTPB operation since 2020 [3, 4]. The UTPB was performed by Dr. Xu, who has been engaged in anesthesiology for 18 years and has mastered the operation of UTPB. Therefore, the TPB operations of the two groups in this study were performed by experienced physicians. TTPB and UTPB are two different approaches of TPB, performed by thoracic surgeons and anesthesiologists, respectively. So we cannot guarantee the balance of their experience levels. We can only ensure that they have rich experience to reduce bias. This does not affect the rigor of this study.

Secondly, this study aims to compare the application of TTPB and UTPB in terms of surgical simplicity, surgical time, success rate of the first puncture, and analgesic effect after thoracoscopic lung cancer radical surgery. However, this study did not focus on opioid retention analgesia strategies, so postoperative opioid analgesia strategies were still incorporated. This does not affect the validity of the research results. Moreover, our research team has conducted research on the application of TTPB in postoperative analgesia with fewer opioids or without opioids entirely, and has achieved preliminary results. We find that TTPB can replace patient-controlled intravenous analgesia (PCIA) for postoperative analgesia after single-port thoracoscopy surgery, achieving a strategy of postoperative analgesia without opioid drugs. If the editor is interested, we are also willing to submit the relevant research manuscript to this journal. The time point observed in this study lasted until 48 h after surgery, and the duration of action of PCIA was also 48 h. Neither group received rescue analgesia after surgery, so there was no significant difference in the consumption of opioid drugs and the number of analgesic rescue between the two groups. At the same time, the comparison of VAS scores between the two groups in this study was sufficient to reflect the postoperative analgesic effect. Considering the main purpose of this study, we did not include the consumption of postoperative opioid drugs and analgesic rescue in this manuscript. Of course, adding these two indicators would also make the research results more convincing.

Thirdly, the surgical time of TPB in the TTPB group was significantly shorter than that in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7 min, t = − 12.411, P < 0.001). But Prof. Xue mentioned that difference of procedure time between-group only was 3.5 min, which was clinically insignificant. TTPB does not require additional disinfection and sterile drapes. It is easy to find the area where the needle needs to be inserted under direct view of thoracoscopy. So the surgical time of TTPB is shorter. However, we mentioned in Sect. “Data Collection” that the surgical time for a block in the UTPB group was considered from the placement of the ultrasound probe on the chest wall to the completion of the drug injection. When performing UTPB surgery in clinical practice, the operator also needs to disinfect the hands and wear sterile surgical gowns. The chest and back areas need to be re-disinfected and covered with sterile wipes, and the ultrasound probe needs to be covered with sterile protective covers. These steps require a significant amount of time. If the surgical time of UTPB in this study is combined with the aforementioned time, it will be much greater than 3.5 min. The success rate of the block is a crucial factor affecting its effectiveness and can be affected by various factors such as block difficulty, technical proficiency, surgical space, and imaging level. The success rate of the first puncture of UTPB performed by experienced anesthesiologists in this study is still lower than that of TTPB. If the doctors are not proficient enough, the success rate may be even lower. The surgical time and success rate of the first puncture of TPB are sufficient to distinguish the difficulty of TTPB and UTPB operations.

Finally, we deeply thank Prof. Xue again for his contribution to this discussion. Prof. Xue is a highly respected anesthesiologist and we are glad to receive his attention and comments. We believe that his comments have added further insights to this study.

Acknowledgements

We thank the participants of the study.

Authors Contributions

Conception and design: Li-hong Hu and Xia Xu; Data curation: Ying-xin Xie and Meng Zhang; Funding acquisition: Li-hong Hu and Jin-xian He; Investigation: Jian-hui Du; Writing-original draft: Xia Xu; UTPB: Xia Xu; Thoracic surgery and TTPB: Jin-xian He. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by Medical and Health Research Project of Zhejiang Province (2023KY1036); Ningbo Health Science and Technology Project (2023Y04). No fee was taken for this article.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Conflict of interest

The authors declared that there are no personal, financial, commercial, or academic conflicts of interest to declare.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Xia Xu and Ying-xin Xie contributed equally to this study.
==== Refs
References

1. Xu X Xie YX Zhang M Du JH He JX Hu LH Comparison of thoracoscopy-guided thoracic paravertebral block and ultrasound-guided thoracic paravertebral block in postoperative analgesia of thoracoscopic lung cancer radical surgery: a randomized controlled trial Pain Ther 2024 13 3 577 588 10.1007/s40122-024-00593-7 38592611
Xu X, Xie YX, Zhang M, Du JH, He JX, Hu LH. Comparison of thoracoscopy-guided thoracic paravertebral block and ultrasound-guided thoracic paravertebral block in postoperative analgesia of thoracoscopic lung cancer radical surgery: a randomized controlled trial. Pain Ther. 2024;13(3):577–88.38592611 10.1007/s40122-024-00593-7
2. Kang DK Kang MK A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung Ann Thorac Med 2022 17 3 180 183 10.4103/atm.atm_128_22 35968396
Kang DK, Kang MK. A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung. Ann Thorac Med. 2022;17(3):180–3.35968396 10.4103/atm.atm_128_22
3. Hu L Xu X Shen W He J Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy Esophagus 2021 18 513 521 10.1007/s10388-020-00807-9 33403428
Hu L, Xu X, Shen W, He J. Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy. Esophagus. 2021;18:513–21.33403428 10.1007/s10388-020-00807-9
4. Hu L Xu X Tian H He J Effect of single-injection thoracic paravertebral block via the intrathoracic approach for analgesia after single-port video-assisted thoracoscopic lung wedge resection: a randomized controlled trial Pain Ther 2021 10 1 433 442 10.1007/s40122-020-00231-y 33420979
Hu L, Xu X, Tian H, He J. Effect of single-injection thoracic paravertebral block via the intrathoracic approach for analgesia after single-port video-assisted thoracoscopic lung wedge resection: a randomized controlled trial. Pain Ther. 2021;10(1):433–42.33420979 10.1007/s40122-020-00231-y
