Comparison of intrathecal morphine versus thoracic paravertebral block for video-assisted thoracoscopic…

Randomized trialRegional anesthesia and pain medicine· Jun 2026

Comparison of intrathecal morphine versus thoracic paravertebral block for video-assisted thoracoscopic surgery: a randomized non-inferiority trial.

Cengiz Kaya, Kubranur Demirkol, Elif Bengi Sener … Hesham Elsharkawy

Regional AnesthesiaRandomized trialTreatmentQ1IF 3.4

Intrathecal morphine gave more postoperative opioid use than paravertebral block after thoracoscopic surgery

Comparison of intrathecal morphine versus thoracic paravertebral block for video-assisted thoracoscopic surgery: a randomized non-inferiority trial.

Cengiz Kaya … Hesham Elsharkawy

Regional anesthesia and pain medicine · Jun 2026 · Q1 in Anesthesiology

Background

Although widely performed, video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery) is associated with significant postoperative pain.

Purpose

We hypothesized that intrathecal morphine would provide analgesic efficacy non-inferior to thoracic paravertebral block in terms of 24-hour intravenous morphine milligram equivalents (intravenous morphine milligram equivalents).

Methods

This was a prospective, randomized, controlled, observer-blinded non-inferiority trial.

n = 36

Results

extra morphine needed beyond paravertebral block over the first 24 hours

MD 6.50 (95% CI 1 to 17)

CI excludes the null - significant

More results

Individual 24-hour and 12-hour intravenous morphine milligram equivalents favored thoracic paravertebral block; rescue analgesia was more frequent with intrathecal morphine (21/36 vs 12/36; p=0.033).

Pain outcomes, quality of recovery scores, and time to first opioid demand were similar, with no respiratory depression.

More results

Although mild 30-day Clavien-Dindo grade I events differed between groups, no apparent clinically meaningful safety signal was observed.

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Conclusion

Intrathecal morphine did not demonstrate non-inferiority to thoracic paravertebral block for 24-hour intravenous morphine milligram equivalents; thoracic paravertebral block was associated with lower systemic opioid use, while pain outcomes were similar.

Comparison of intrathecal morphine versus thoracic paravertebral block for video-assisted thoracoscopic surgery: a randomized non-inferiority trial.

Comparison of intrathecal morphine versus thoracic paravertebral block for video-assisted thoracoscopic surgery: a randomized non-inferiority trial.

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