• Ling Jiang, Chengyu Wang, Jie Tong, Xiaodan Han, Changhong Miao, and Chao Liang.
• Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
• J Clin Anesth. 2025 Jan 1; 100: 111685111685.

Study ObjectiveTo test the hypothesis that thoracic epidural anesthesia and analgesia (TEA) reduces the incidence of chronic postoperative pain (CPSP) after video-assisted thoracoscopic surgery (VATS).DesignA single-center, single-blind, randomized controlled trial was conducted.SettingThe study was conducted in the operating room, with follow-up assessments performed in the ward. Telephone was used to follow the long-term outcomes.Patients231 patients ≥18 years of age and scheduled for VATS.InterventionsPatients were randomized into two groups, including an epidural block (EPI) group (general anesthesia with patient-controlled epidural analgesia) and a general anesthesia with patient-controlled intravenous analgesia (PCIA) group.MeasurementsThe primary endpoint was the incidence of CPSP at 3 months postoperatively. CPSP data, including acute pain, neuropathic pain, depression, and side effects, were collected at 3 and 6 months postoperatively through telephone follow-up.Main ResultsA total of 231 patients were analyzed, including 114 in the PCIA group and 117 in the EPI group. Sixty-six patients (56.4 %) in the PCIA group and 33 patients (28.9 %) in the EPI group experienced chronic pain at 3 months postoperatively. The odds ratio (OR) was 0.31 (95 % confidence interval [CI], 0.18 to 0.54; P < 0.0001). After adjusting for confounding factors, the adjusted OR was 0.28 (95 % CI, 0.16 to 0.50, P < 0.001). Six months postoperatively, 50 (42.7 %) and 17 (14.9 %) patients in the PCIA and EPI groups, respectively, were diagnosed with CPSP (P < 0.0001).Copyright © 2024 Elsevier Inc. All rights reserved.

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