PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations |
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Authors: | S. Feray J. Lubach G. P. Joshi F. Bonnet M. Van de Velde the PROSPECT Working Group *of the European Society of Regional Anaesthesia Pain Therapy |
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Affiliation: | 1. Department of Anaesthesia, Intensive Care and Peri-operative Medicine, Hôpital Tenon, Paris, France;2. Department of Anaesthesiology, KU Leuven and University Hospital Leuven, Leuven, Belgium;3. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA;4. Department of Cardiovascular Sciences, KU Leuven and University Hospital Leuven, Leuven, Belgium |
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Abstract: | Video-assisted thoracoscopic surgery has become increasingly popular due to faster recovery times and reduced postoperative pain compared with thoracotomy. However, analgesic regimens for video-assisted thoracoscopic surgery vary significantly. The goal of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after video-assisted thoracoscopic surgery. A systematic review was undertaken using procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials published in the English language, between January 2010 and January 2021 assessing the effect of analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies of which 69 randomised controlled trials and two reviews met inclusion criteria. We recommend the administration of basic analgesia including paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2-specific inhibitors pre-operatively or intra-operatively and continued postoperatively. Intra-operative intravenous dexmedetomidine infusion may be used, specifically when basic analgesia and regional analgesic techniques could not be given. In addition, a paravertebral block or erector spinae plane block is recommended as a first-choice option. A serratus anterior plane block could also be administered as a second-choice option. Opioids should be reserved as rescue analgesics in the postoperative period. |
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Keywords: | analgesia evidence-based medicine postoperative pain systematic review video-assisted thoracoscopic surgery |
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