BACKGROUND: There is lack of the clinical evidence of optimized perioperative analgesic protocol for uniportal video-assisted thoracoscopic surgery (uVATS). METHODS: We performed a RCT enrolling participants scheduled for uVATS (Trial registration: NCT06016777
registration date: Aug 28, 2023). Participants were randomized for thoracic paravertebral block combined with patient-controlled intravenous analgesia (PVB + PCIA), erector spinae block combined with PCIA (ESPB + PCIA), or PCIA group. Participants were followed-up till 6 months. Primary outcome was total opioid consumption. Secondary outcomes included postoperative rest and cough pain scores, ambulation time, chest tube duration, length of stay, anaesthesia expense and adverse events. RESULTS: We enrolled 108 participants between October 16th, 2023 to April 14th, 2024. Neural block did not reduce opioid consumption. Postoperative rest and cough pain scores did not differ among the groups at all the follow-up time points. None of the participants experienced chronic pain. The ambulation time, duration of chest tube maintenance and length of stay did not differ among groups. Duration of anaesthesia procedure was significantly prolonged in both neural blockade groups compared to PCIA group (p = 0.033). Anaesthesia expenses were significantly higher in both nerve block groups than in the PCIA group (p <
0.001). Adverse events related to neural blockade occurred in 17.9% in PVB + PCIA group and 2.9% in ESPB + PCIA group (p = 0.010), including local haemorrhage and block failure. Adverse events related to opioid use did not differ among groups. CONCLUSIONS: Both PVB and ESPB did not exhibit analgesic advantage for uVATS. Neural block may carry the risk of haemorrhage and block failure, prolonged the anaesthesia procedure and increased the anaesthesia expenses. TRIAL REGISTRATION: Clinical Trial Number was NCT06016777, trial registration date was Aug 28th, 2023.