Efficacy and safety of intercostal nerve block for postoperative analgesia in patients with stage III tuberculous empyema: a retrospective study based on propensity score matching

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Background: Stage III tuberculous empyema causes irreversible thoracic pathologies and secondary deformities, with traditional thoracotomy/video-assisted thoracoscopic surgery (VATS) as main treatments. However, its postoperative pain is severe (due to extensive tissue damage) and understudied-existing analgesic research for this population is scarce and biased, while unmanaged pain worsens patient quality of life. This study aimed to evaluate the efficacy of intercostal nerve block (INB) combined with patient-controlled intravenous analgesia (PCIA) for postoperative pain management in patients with stage III tuberculous empyema. Methods: Clinical data of 315 patients with tuberculous empyema admitted to Xi'an Chest Hospital from August 9, 2020 to March 25, 2025 were retrospectively analyzed. Patients were divided into group A (n=54, INB + PCIA + oral medications) and group B (n=261, PCIA + oral medications). General clinical data, postoperative Numerical Rating Scale (NRS) scores, frequency of rescue analgesia, postoperative tube indwelling time, drainage volume, and hospitalization costs were compared between groups. Propensity score matching (PSM) was performed to control for confounding factors. Statistical analyses included the t-test, Chi-squared test, rank sum test, etc., and sensitivity analysis was conducted by excluding data from the first two years. Results: 0.00 (0.00, 1.00) in group B (Z=-2.43; P=0.02). No significant differences were observed in 24-hour thoracic drainage volume, total drainage volume, thoracic drainage tube indwelling time, postoperative discharge time, or total hospitalization costs (all P>0.05). Conclusions: In patients with stage III tuberculous empyema, INB administered before chest closure combined with PCIA and oral medications enhances postoperative analgesic efficacy and reduces the need for rescue analgesia.

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