Development of Clinical Practice Guidelines for Incorporating Paravertebral Blockade for Thoracic Surgery Adult Patients

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of intravenous and oral opioids alone. This project aims to provide evidence-based guidelines to incorporate regional anesthesia for postoperative pain management in adult patients undergoing unilateral thoracic surgery. Paravertebral blockade (PVB) is the recommended regional anesthesia technique based on the quality of pain control coupled with the low rate of postoperative complications. Regional anesthesia is widely considered the gold standard of pain management following thoracic surgery and should be implemented as part of a thoracic Enhanced Recovery After Surgery (ERAS) protocol. Providers and nurses will be educated regarding PVB ultrasound-guided technique and proper documentation, respectively. Guidelines for incorporating PVB into thoracic ERAS protocols have been established and will be recommended to the hospital for review and discussion of potential implementation. The intent is for the guidelines to be utilized for all thoracic surgeries to ensure adequate postoperative pain control while minimizing associated complications, length of stay, and hospital costs.