Steinthorsdottir Kristin Julia, Wildgaard Lorna, Hansen Henrik Jessen, Petersen René Horsleben, Wildgaard Kim
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
The Royal School of Library and Information Science, University of Copenhagen, Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2014 Jun;45(6):959-66. doi: 10.1093/ejcts/ezt525. Epub 2013 Nov 27.
Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncological lung surgery. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are established analgesic golden standards for open surgery such as thoracotomy; however, there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques with regard to effect on acute postoperative pain following VATS, with emphasis on VATS lobectomy. The systematic review of PubMed, The Cochrane Library and Embase databases yielded 1542 unique abstracts; 17 articles were included for qualitative assessment, of which three were studies on VATS lobectomy. The analgesic techniques included TEA, multilevel and single PVB, paravertebral catheter, intercostal catheter, interpleural infusion and long thoracic nerve block. Overall, the studies were heterogeneous with small numbers of participants. In comparative studies, TEA and especially PVB showed some effect on pain scores, but were often compared with an inferior analgesic treatment. Other techniques showed no unequivocal results. No clear gold standard for regional analgesia for VATS could be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS is presented.
电视辅助胸腔镜手术（VATS）正在成为小型和大型肿瘤性肺部手术的标准外科手术方法。胸段硬膜外镇痛（TEA）和椎旁阻滞（PVB）是开胸手术（如胸廓切开术）公认的镇痛金标准；然而，VATS的区域镇痛尚无金标准。本系统评价旨在评估不同区域技术对VATS术后急性疼痛的影响，重点是VATS肺叶切除术。对PubMed、Cochrane图书馆和Embase数据库进行系统评价，共获得1542篇独特摘要；纳入17篇文章进行定性评估，其中3篇是关于VATS肺叶切除术的研究。镇痛技术包括TEA、多级和单级PVB、椎旁导管、肋间导管、胸膜内输注和胸长神经阻滞。总体而言，这些研究存在异质性，参与者数量较少。在比较研究中，TEA尤其是PVB对疼痛评分有一定影响，但常与较差的镇痛治疗进行比较。其他技术未显示明确结果。VATS区域镇痛尚无明确的金标准，但给出了未来VATS区域镇痛研究应考虑的因素指南。
