Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Acta Anaesthesiol Scand. 2025 Jan;69(1):e14546. doi: 10.1111/aas.14546.
Postoperative pain following video-assisted thoracoscopic surgery (VATS) remains a significant challenge. While epidural analgesia is still the gold standard, other types of regional analgesia are gaining popularity because of perceived less risk of complications. The efficacy of systemic opioids as an alternative to epidural analgesia has not been thoroughly explored. This systematic review and meta-analysis aims to evaluate and compare the efficacy of systemic opioids versus epidural analgesia in managing postoperative pain after VATS.
We will conduct a systematic review and meta-analysis in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. A comprehensive search will be conducted in MEDLINE, EMBASE, and the Cochrane Library supplemented with Scopus citation searches, search for gray literature using Google Scholar and a search for ongoing studies. We will include studies based on the PICO methodology without restrictions regarding study type. Two independent reviewers will screen studies, extract data, and assess study quality using the Cochrane Risk of Bias tools. The primary outcomes will be postoperative pain intensity at rest and during activity at 24, 48, and 72 h. Secondary outcomes will include use of "rescue" opioids, hospital length of stay, and adverse events. If feasible, a meta-analysis will be done, otherwise we will perform a descriptive analysis.
The results will provide a comparative analysis of the effectiveness of systemic opioids versus epidural analgesia in managing postoperative pain in VATS patients. Data synthesis will include pooled estimates for pain scores, opioid consumption, and adverse events, possibly with subgroup and sensitivity analyses conducted to explore heterogeneity across studies.
This systematic review will offer valuable insights into the optimal pain management strategy for patients undergoing VATS. The findings may guide clinical practice in selecting the most effective and safe analgesic approach, improving postoperative recovery, and patient outcomes.
电视辅助胸腔镜手术（VATS）后的术后疼痛仍然是一个重大挑战。尽管硬膜外镇痛仍然是金标准，但由于并发症风险较低，其他类型的区域镇痛方法越来越受欢迎。与硬膜外镇痛相比，全身阿片类药物作为替代方法的疗效尚未得到充分探讨。本系统评价和荟萃分析旨在评估和比较全身阿片类药物与硬膜外镇痛在管理 VATS 后术后疼痛的疗效。
我们将根据 Cochrane 手册和系统评价和荟萃分析报告的首选项目（PRISMA-P）清单进行系统评价和荟萃分析。将在 MEDLINE、EMBASE 和 Cochrane 图书馆进行全面搜索，并补充 Scopus 引文搜索，使用 Google Scholar 搜索灰色文献，并搜索正在进行的研究。我们将根据 PICO 方法学纳入研究，不限制研究类型。两名独立评审员将筛选研究、提取数据，并使用 Cochrane 偏倚风险工具评估研究质量。主要结局将是术后 24、48 和 72 小时静息和活动时的疼痛强度。次要结局将包括“解救”阿片类药物的使用、住院时间和不良事件。如果可行，将进行荟萃分析，否则将进行描述性分析。
结果将提供 VATS 患者全身阿片类药物与硬膜外镇痛在管理术后疼痛方面的有效性比较分析。数据综合将包括疼痛评分、阿片类药物消耗和不良事件的汇总估计值，可能进行亚组和敏感性分析，以探索研究之间的异质性。
本系统评价将为 VATS 患者提供最佳疼痛管理策略的有价值见解。研究结果可能为选择最有效和安全的镇痛方法指导临床实践提供信息，改善术后恢复和患者结局。
