Ultrasound-guided intertransverse process block for video-assisted thoracoscopic surgery (VATS) in a pediatric patient: A case report

Video-assisted thoracoscopic surgery (VATS) is widely adopted in pediatric populations but remains associated with significant postoperative pain due to pleural irritation, intercostal nerve involvement, and chest tube placement. Regional anesthesia is a cornerstone of multimodal analgesia in this setting, aiming to minimize opioid use and related adverse effects. We describe the successful application of an ultrasound-guided costotransverse foramen block (CTFB), now classified under the intertransverse process block nomenclature, for postoperative analgesia in a 14-year-old male undergoing elective VATS bullectomy. Following induction of general anesthesia and appropriate airway management, a unilateral CTFB was performed at the T5 level under real-time ultrasound guidance using 0.4 mL/kg of 0.25 % bupivacaine. Accurate needle placement and local anesthetic spread toward the paravertebral space were confirmed sonographically. The patient's postoperative pain scores were remarkably low, with a Visual Analog Scale (VAS) of 2 at 30 min, 1 at 1 h, and 0 thereafter up to 24 h. No rescue analgesics were required, and no perioperative complications, agitation, or respiratory compromise occurred. This clinical outcome suggests effective somatic and visceral pain control with a single-shot CTFB. The technique offers several advantages, including safety due to its distance from pleura and neuraxial structures, reproducible injectate spread, and opioid-sparing potential, making it particularly suitable for pediatric patients. To our knowledge, this is the first reported use of CTFB in a pediatric VATS case, supporting its integration into multimodal analgesia strategies and warranting further study in larger pediatric cohorts.