Vorm Bertram, Jeppesen Anni Nørgaard, Hansen Lene Mølgaard, Lumholdt Mads, Klitgaard Thomas Lass, Danielsen Allan Vestergaard, Juhl-Olsen Peter, Sperling Phillip, Bisgaard Jannie
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Department of Cardiothoracic Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Acta Anaesthesiol Scand. 2025 Mar;69(3):e14577. doi: 10.1111/aas.14577.
Video-assisted thoracoscopic surgery (VATS) is widely used in lung cancer surgery, as this technique causes less pain and faster recovery than open thoracotomy. However, significant postoperative pain persists in a number of patients, often leading to increased opioid use and opioid-related adverse events in addition to prolonged admission times. Perioperatively administered glucocorticoids have been demonstrated effective in reducing pain after other types of surgeries, but the effect in VATS remains unclear.
This systematic review will assess the impact of glucocorticoids on postoperative pain in adult patients undergoing VATS. We will include randomised trials comparing higher doses of glucocorticoids to lower doses, placebo or no treatment. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and Cochrane methodology. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation system. The primary outcome is standardised dynamic pain scores within 24 h. Secondary outcomes are opioid use, time to first mobilisation, length of hospital stay and numeric rating score >3 at any point within the first 24 h following surgery. Exploratory outcomes are opioid-related adverse effects and glucocorticoid-related adverse effects classified in major and minor events. Data will be meta-analysed with sensitivity and subgroup analyses and trial sequential analyses. Furthermore, we will assess the risk of reporting bias and heterogeneity.
This systematic review and meta-analysis will provide an overview of the current evidence of how glucocorticoids affect postoperative pain and recovery in adult patients undergoing VATS.
电视辅助胸腔镜手术（VATS）在肺癌手术中被广泛应用，因为该技术相较于开胸手术引起的疼痛更少且恢复更快。然而，许多患者术后仍存在明显疼痛，这除了会导致住院时间延长外，还常常会增加阿片类药物的使用以及与阿片类药物相关的不良事件。围手术期给予糖皮质激素已被证明在其他类型手术中可有效减轻疼痛，但在VATS中的效果仍不明确。
本系统评价将评估糖皮质激素对接受VATS的成年患者术后疼痛的影响。我们将纳入比较高剂量糖皮质激素与低剂量、安慰剂或不治疗的随机试验。该评价将遵循系统评价和Meta分析的首选报告项目声明以及Cochrane方法。将使用推荐分级评估、制定和评价系统评估证据的确定性。主要结局是24小时内的标准化动态疼痛评分。次要结局包括阿片类药物的使用、首次活动时间、住院时间以及术后24小时内任何时间的数字评分>3。探索性结局是分为主要和次要事件的与阿片类药物相关的不良反应以及与糖皮质激素相关的不良反应。数据将进行Meta分析，并进行敏感性分析、亚组分析和试验序贯分析。此外，我们将评估报告偏倚和异质性的风险。
本系统评价和Meta分析将概述目前关于糖皮质激素如何影响接受VATS的成年患者术后疼痛和恢复的证据。
