Optimizing postoperative outcomes is a priority in modern thoracic surgery. While thoracic paravertebral block (TPVB) provides effective analgesia, many women still experience significant discomfort from non-analgesic factors. Recent evidence highlights how a two-stage diphenhydramine recovery VATS regimen can address these recovery barriers effectively. Hormonal and central emetic pathways often lead to persistent nausea and sleep disturbances despite well-controlled pain.

Benefits of Two-Stage Diphenhydramine Recovery VATS

Researchers conducted a prospective, randomized, double-blind trial involving 80 women undergoing pulmonary resection. They administered a 0.2 mg/kg bolus of diphenhydramine at chest closure. Subsequently, patients received 0.5 mg/kg via postoperative patient-controlled intravenous analgesia (PCIA). This approach aimed to enhance the Quality of Recovery-15 (QoR-15) scores within the first 24 hours.

The results were compelling. Patients in the diphenhydramine group showed significantly higher median QoR-15 scores compared to the placebo group. Specifically, the treatment group reported markedly better sleep quality. Furthermore, these patients experienced lower incidences of postoperative nausea and vomiting. Consequently, the addition of diphenhydramine reduced the need for rescue antiemetics and analgesics during the early recovery phase.

Safety is always a concern in perioperative care. Fortunately, the study noted no significant increase in adverse events like over-sedation or dry mouth. Therefore, clinicians can consider this low-cost antihistamine as a valuable adjunct to TPVB-based multimodal analgesia. Notably, the improved sleep and reduced PONV contribute to a more holistic recovery experience for female patients.

Frequently Asked Questions

Can diphenhydramine improve sleep after surgery?

Yes, research shows that a two-stage diphenhydramine regimen significantly improves sleep quality by lowering insomnia scores in the first 48 hours post-surgery.

Does diphenhydramine reduce postoperative nausea?

Indeed, this antihistamine helps manage postoperative nausea and vomiting (PONV) by targeting central emetic pathways that analgesics alone might not reach.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a substitute for professional healthcare. Always consult a qualified medical professional for diagnosis and treatment. Refer to the latest local and national guidelines for clinical practice.

References

Yin JW et al. Two‑stage diphenhydramine improves early recovery in women after video‑assisted thoracoscopic surgery: a randomized controlled trial. J Anesth. 2026 May 03. doi: 10.1007/s00540-026-03759-z. PMID: 42070219.

Anales Médicos. Current developments in the management of post-operative nausea and vomiting. 2025; 70(2): 112-118.

Bahrain Medical Bulletin. Effect of Pretreatment with Diphenhydramine on Recovery Complications in Minor Ear, Nose and Throat Surgeries: A Randomized Clinical Trial. 2024.