Microwave ablation for subpleural stage I non-small cell lung cancer: a prospective, single-center study comparing three anesthesia models.

Objectives: To compare the analgesic efficacy and safety of three anesthetic techniques during microwave ablation (MWA) for subpleural stage I non-small cell lung cancer (NSCLC).

Materials and methods: This prospective, single-center clinical trial enrolled patients with subpleural stage I NSCLC between January 2024 and December 2024. Patients were assigned to one of three anesthesia groups: intercostal nerve block (INB), pleural infiltration anesthesia (PIA), or local anesthesia (LA). The primary endpoints were perioperative visual analog scale (VAS) scores and the incidence of adverse events within 30 days of MWA.

Results: Sixty patients (mean age 73.88 ± 6.44 years; 28 men) were included in the analysis. The PIA group had intraoperative VAS scores comparable to the INB group and significantly lower than the LA group (2.70 ± 1.34 vs. 2.85 ± 1.73 vs. 6.26 ± 1.41, respectively). Postoperatively, VAS scores at 2 h were significantly lower in the PIA and INB groups compared to the LA group; however, no statistically significant difference was observed between the PIA and INB groups (0.80 ± 1.24 vs. 1.35 ± 1.63 vs. 2.25 ± 1.02). There was no significant difference in VAS scores at 24 h post-ablation (0.80 ± 1.24 vs. 1.40 ± 1.57 vs. 1.50 ± 1.64). The technical success and efficacy rates were 100%. No procedure-related deaths occurred within 30 days of MWA, and most adverse events were minor.

Conclusion: INB and PIA significantly reduced perioperative pain compared to LA. No significant difference in adverse events incidence was observed among the three groups.