Pain relief concept

Beyond the Block: Is the MTP Block a Game-Changer for Post-Thoracoscopic Pain?

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"A novel approach to pain management after video-assisted thoracoscopic surgery (VATS) is under investigation."

Video-assisted thoracoscopic surgery (VATS) has become a standard approach for many thoracic procedures, but effective postoperative pain management remains a challenge. Traditional methods like epidural analgesia and thoracic paravertebral blocks (PVB) have potential drawbacks, including complications and limited suitability for high-risk patients.

A recent letter to the editor in 'Minerva Anestesiologica' explores a promising alternative: the mid-point transverse process to pleura (MTP) block. This novel technique aims to provide effective analgesia while potentially reducing the risks associated with conventional methods.

The MTP block involves injecting local anesthetic at the midpoint between the transverse process and pleura, targeting the paravertebral space. The authors propose that this approach may offer a simpler, safer option with a lower risk of pleural puncture and neurovascular injury.

MTP Block: A Simpler, Safer Alternative for VATS Analgesia?

The authors detail a case where the MTP block was successfully used for postoperative pain management in a patient undergoing VATS lobectomy. A combination of ropivacaine, fentanyl, and acetaminophen was administered during and after the procedure. Postoperatively, the patient reported a sensory block in the T3-T7 dermatomes on the right side, with good analgesia and a pain score of less than 4 on the Numeric Rating Scale.

The case suggests that the MTP block may represent a viable alternative to traditional regional techniques for VATS lobectomy. Here's a comparison of key considerations:

Efficacy: The MTP block provided effective pain relief in the reported case, comparable to PVB.
Safety: By targeting the midpoint between the transverse process and pleura, the MTP block may reduce the risk of pleural puncture.
Simplicity: The MTP block may be technically easier to perform than PVB, potentially lowering the learning curve for practitioners.
Patient Suitability: The MTP block may be a suitable option for patients in whom epidural analgesia or PVB are contraindicated or considered high-risk.

Despite these potential advantages, the authors emphasize that further investigation is necessary to confirm the real effectiveness of this technique and elucidate its enigma.

The Future of Pain Management in VATS

The MTP block represents a promising step forward in the ongoing effort to optimize pain management after VATS. While further research is needed to fully understand its effectiveness and safety profile, this novel technique has the potential to improve patient outcomes and reduce the risks associated with traditional methods. As the field of regional anesthesia continues to evolve, innovative approaches like the MTP block may play an increasingly important role in providing comprehensive, patient-centered care.

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Everything You Need To Know

What is the Mid-Point Transverse Process to Pleura (MTP) block?

The Mid-Point Transverse Process to Pleura (MTP) block is a novel approach to pain management that is being investigated for use after video-assisted thoracoscopic surgery (VATS). It involves injecting a local anesthetic at the midpoint between the transverse process and pleura, with the aim of targeting the paravertebral space. The MTP block is proposed as a simpler and potentially safer alternative to traditional pain management methods such as epidural analgesia and thoracic paravertebral blocks (PVB).

How does the MTP block compare to other pain management methods like epidural analgesia and the thoracic paravertebral block (PVB) for VATS procedures?

Compared to traditional methods such as epidural analgesia and thoracic paravertebral blocks (PVB), the MTP block presents potential advantages. The MTP block may be simpler to perform, potentially reducing the learning curve for practitioners. Safety may be improved because the MTP block targets the midpoint between the transverse process and pleura, potentially lowering the risk of pleural puncture and neurovascular injury, risks associated with PVB. However, it is important to note that the benefits of the MTP block are still under investigation, and further research is needed to confirm its effectiveness and safety profile.

What are the potential benefits of using the MTP block for pain management after VATS lobectomy?

The MTP block may offer several potential benefits for pain management following video-assisted thoracoscopic surgery (VATS) lobectomy. It could provide effective analgesia, comparable to that of thoracic paravertebral blocks (PVB). The MTP block's technique might reduce the risk of complications such as pleural puncture and neurovascular injury, as it targets a specific anatomical location. Furthermore, it may be a suitable option for patients for whom epidural analgesia or PVB are not appropriate. The simplicity of the MTP block may also be a significant advantage, as it could make the procedure easier to perform.

What kind of drugs were used in the MTP block case discussed?

In the reported case, a combination of ropivacaine, fentanyl, and acetaminophen was administered during and after the Mid-Point Transverse Process to Pleura (MTP) block procedure. This combination was used to provide postoperative pain management for a patient undergoing VATS lobectomy. The patient experienced a sensory block in the T3-T7 dermatomes on the right side, indicating effective pain relief.

What are the key considerations when evaluating the MTP block for VATS analgesia?

When evaluating the Mid-Point Transverse Process to Pleura (MTP) block for video-assisted thoracoscopic surgery (VATS) analgesia, key considerations include efficacy, safety, simplicity, and patient suitability. Efficacy refers to the block's ability to provide effective pain relief, safety addresses the potential risks, and simplicity assesses the technical ease of performing the block. Patient suitability determines if the MTP block is a viable option for specific patients, especially those for whom traditional methods like epidural analgesia or thoracic paravertebral blocks (PVB) are not appropriate or carry higher risks. It is important to acknowledge that while promising, further research is required to confirm these aspects and fully understand the benefits of the MTP block.