Figure 1.

Schematic representation of post-operative pain management strategy after VATS lobectomy. The pre-operative patient assessment allows to set the analgesic plan. The cornerstone is always the inclusion of a loco-regional technique. Thoracic epidural analgesia should be considered if there is a high risk of conversion to thoracotomy. Otherwise thoracic paravertebral block is considered the first-line loco-regional technique. If not feasible, it can be replaced with intercostal nerve block or serratus anterior plane block. These techniques must be always integrated with systemic analgesia to meet the criteria of multimodal analgesia. LR, loco-regional; TEA, thoracic epidural analgesia; TPVB, thoracic paravertebral block; ICNB, intercostal nerve block; SAPB, serratus anterior plane block; NSAID, nonsteroidal anti-inflammatory drug; PCA, patient-controlled analgesia; VATS, video-assisted thoracoscopic surgery.