EP189 Paravertebral block for enhanced recovery after non-intubated video-assisted thoracoscopic surgery wedge resection in a patient with breast cancer and bronchiectasis: a case report

<h3>Background and Aims</h3> The implementation of Enhanced Recovery After Surgery (ERAS) protocols has gained prominence in thoracic surgery. Advances in video-assisted thoracoscopic surgery (VATS) have increased interest in non-intubated techniques, which reduce physiological stress and promote faster recovery. This case highlights the use of thoracic paravertebral block (PVB) as the sole anesthetic for non-intubated VATS in a high-risk patient. <h3>Methods</h3> A 62-year-old female (ASA II) with breast cancer and pulmonary bronchiectasis was scheduled for right VATS wedge resection. A two-level right-sided PVB was done at T4 and T6 using 0.4% isobaric bupivacaine with 1:400,000 epinephrine. Sensory block from T2 to T7 was confirmed. A 5 mL vagal block with 0.5% bupivacaine was added to prevent cough. Sedation was maintained with dexmedetomidine (0.2 mcg/kg/hr) and remifentanil (2 ng/mL). <h3>Results</h3> The patient remained hemodynamically stable and reported minimal postoperative pain, managed with paracetamol, ketorolac, and oral celecoxib. She was mobilized the same day and discharged the next day. Thoracic PVB provides effective anesthesia and analgesia without airway instrumentation, lowering risks in patients with compromised lungs. Its use in NIVATS supports opioid-free perioperative care and aligns with ERAS principles. Regional anesthesia with sedation provided stable intraoperative conditions, excellent pain control, and early recovery. <h3>Conclusions</h3> Ultrasound-guided PVB in NIVATS offers excellent anesthesia and pain management, promoting early recovery. While risks in performing this block exist, the use of ultrasound guidance can reduce complications. Further research is needed to determine specific demographic factors influencing the success of NIVATS under paravertebral block.