Targeted intrapleural analgesia through an integrated chest tube after thoracoscopic lung resection: a randomized controlled trial.

BACKGROUND: Chest drains are a major contributor to postoperative pain after thoracoscopic lung resection. Localized intrapleural analgesia delivered through the drain itself may provide targeted pain control without additional catheters. This study evaluated whether a drainage-analgesia integrated (DAI) chest tube improves postoperative analgesia after video-assisted thoracoscopic surgery (VATS). METHODS: In this prospective single-center, open-label randomized trial, 47 patients undergoing VATS were allocated to receive either a DAI chest tube (n=22) or standard drainage (STD) chest tube (n=25). Both groups received identical multimodal systemic analgesia, including intravenous patient-controlled analgesia (PCA) with a continuous background sufentanil infusion. The primary endpoint was the visual analog scale (VAS) pain score at 24 hours. The secondary outcomes included PCA activation frequency, sufentanil consumption, drainage outcomes, adverse events, and Quality of Recovery-15 (QoR-15) scores. RESULTS: Compared with the STD group, the DAI group had lower VAS pain scores at 24 and 48 hours after surgery (P<0.05). Total sufentanil consumption was similar between the two groups (P=0.49); however, the number of PCA activations was lower in the DAI group than in the STD group (0.1±0.4 vs. 0.9±1.1; P=0.004). QoR-15 scores at 48 hours were higher in the DAI group than in the STD group, indicating improved patient-reported recovery. No device-related complications were observed. CONCLUSIONS: In this open-label randomized trial conducted under a standardized background sufentanil PCA regimen, intrapleural local anesthetic delivery through an integrated chest tube was associated with lower early postoperative pain scores and fewer PCA activation attempts. This strategy may represent a simple approach for targeted analgesia within enhanced recovery after surgery (ERAS) pathways for thoracic surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2500115142.