PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

Anaesthesia, Год журнала: 2021, Номер 77(3), С. 311 - 325

Опубликована: Ноя. 5, 2021

Summary 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 vary significantly. The goal of this systematic review was evaluate the available literature develop recommendations optimal management after surgery. A undertaken using procedure‐specific (PROSPECT) methodology. Randomised controlled trials published in English language, between January 2010 2021 assessing effect analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies which 69 randomised two reviews met inclusion criteria. recommend administration basic analgesia including paracetamol non‐steroidal anti‐inflammatory drugs cyclo‐oxygenase‐2‐specific inhibitors pre‐operatively intra‐operatively continued postoperatively. Intra‐operative intravenous dexmedetomidine infusion may be used, specifically when regional techniques could not given. In addition, a paravertebral block erector spinae plane is recommended as first‐choice option. serratus anterior also administered second‐choice Opioids should reserved rescue analgesics period.

Язык: Английский

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Ultrasound-guided single thoracic paravertebral nerve block and erector spinae plane block for perioperative analgesia in thoracoscopic pulmonary lobectomy: a randomized controlled trial

Insights into Imaging, Год журнала: 2022, Номер 13(1)

Опубликована: Янв. 28, 2022

To explore the effect of a single preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) and erector spinae plane (ESPB) for perioperative analgesia in thoracoscopic pulmonary lobectomy.Seventy-two patients aged 40-70 years who underwent lobectomy under general anesthesia were enrolled randomly divided into control group (Group C), TPVB T) ESPB E). The primary observation indicators included visual analogue scale (VAS) at 1, 6, 12, 24, 48 h postoperatively rest with cough. secondary intraoperative sufentanil consumption, awakening time extubation time, consumption analgesic pump, flurbiprofen ester remedial within after surgery incidence postoperative adverse events.The lower groups T E than those C (p < 0.05). Patients had VAS scores cough 12 same points 1 6 coughing status 0.05).The could both reduce pain score dose analgesics.

Язык: Английский

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Impact of Regional Anesthesia on Subjective Quality of Recovery in Patients Undergoing Thoracic Surgery: A Systematic Review and Meta-Analysis

Journal of Cardiothoracic and Vascular Anesthesia, Год журнала: 2023, Номер 37(9), С. 1744 - 1750

Опубликована: Май 5, 2023

Язык: Английский

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Bayesian Network Meta-Analysis of Postoperative Analgesic Techniques in Thoracoscopic Lung Resection Patients

Pain and Therapy, Год журнала: 2025, Номер unknown

Опубликована: Фев. 22, 2025

Postoperative analgesia in thoracoscopic lung resection is crucial, with several nerve block techniques—including thoracic epidural anesthesia (TEA), paravertebral (PVB), erector spinae plane (ESPB), intercostal (INB), and serratus anterior (SAPB)—commonly employed. However, there remains ongoing debate regarding the optimal technique. To evaluate compare effectiveness of these methods, a systematic review was conducted across multiple databases, including PubMed, Embase, Web Science, Cochrane Library, identifying relevant randomized clinical trials (RCTs). A Bayesian network meta-analysis performed to assess postoperative pain management, subgroup analyses meta-regression examine key factors influencing outcomes, such as risk bias, continuous catheter analgesia, patient-controlled (PCA). The results revealed that for 12-h resting visual analog scale (VAS) scores, surface under cumulative ranking curve (SUCRA) TEA > PVB ESPB control INB SAPB, whereas at 24 h, it shifted SAPB. For coughing VAS ranked highest, followed by PVB, ESPB, control. At TEA, INB, inconsistency test showed good consistency, minimal publication neither study quality nor local anesthetic infiltration incision site significantly impacted outcomes. Excluding studies without PCA did not change SUCRA rankings. consistently highest 24-h scores. Clustered plots indicated were most suitable techniques analgesia. emerged analgesic resection. While superior efficacy, offered fewer side effects, providing safety advantage. considered less due its excessive effects.

Язык: Английский

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Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis

Interdisciplinary CardioVascular and Thoracic Surgery, Год журнала: 2023, Номер 36(1)

Опубликована: Янв. 1, 2023

Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding analgesia. We performed a systematic review meta-analysis to determine mean pain scores different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia only systemic analgesia) anatomical lung resection.Medline, Embase Cochrane databases were searched until 1 October 2022. Patients undergoing at least >70% resections through thoracoscopy reporting included. Due high inter-study variability an explorative next analytic was performed. The quality evidence has been evaluated using Grading Recommendations Assessment, Development Evaluation system.A total 51 studies comprising 5573 patients Mean 24, 48 72 h with 95% confidence interval on 0-10 scale calculated. Length hospital stay, nausea vomiting, additional opioids use rescue analysed as secondary outcomes. A common-effect size estimated extreme heterogeneity for which pooling not appropriate. An exploratory demonstrated acceptable Numeric Rating Scale <4 all techniques.This extensive literature attempt pool demonstrates that is gaining popularity over thoracic in resection, despite great limitations current precluding such recommendations.ID number 205311.

Язык: Английский

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Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis

Journal of Pain Research, Год журнала: 2023, Номер Volume 16, С. 707 - 724

Опубликована: Март 1, 2023

Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various fascial plane vs TEA PVB intraoperative postoperative video assisted thoracoscopy surgery (VATS) with network meta-analysis.A search prospective randomized control studies using adult patients undergoing VATS general anesthesia. The interventions interest were any regional anesthesia used after VATS. Primary outcomes 24-hour opioid requirement scores. A Bayesian meta-analysis was conducted.We identified 42 that fulfilled our inclusion criteria. For who underwent VATS, (MD = -27MME, 95% CI -46.2 to -9MME), ESP -20MME, -33 -7.9MME), -15MME, -26 -4.5MME) demonstrated significant sparing efficacy, as well reduction cumulative static However, exclusion one study due high risk bias revealed did not significantly reduce consumption, nor it incidence PONV, pulmonary complications, or LOS when compared ESP, SAP, PVB, ICN, PECS blocks.Our findings suggest provide superior relief following Therefore, propose a suitable intervention prevention

Язык: Английский

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Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial

BMC Anesthesiology, Год журнала: 2024, Номер 24(1)

Опубликована: Янв. 4, 2024

Abstract Background Although video-assisted thoracoscopic surgery (VATS) has advantages of reduced injury and faster healing, patients still endure moderate severe postoperative pain. Paracetamol mannitol injection, the first acetaminophen injection in China, convenient administration, rapid onset action, no first-pass effect. This aim this study was to investigate efficacy analgesia with paracetamol combined thoracic paravertebral nerve block (TPVB) post VATS Methods a single-center, prospective, randomized, double-blind controlled clinical trial. Patients scheduled for were randomly divided into three groups, general anesthesia group (Group C), TPVB T) + TP). In study, primary outcome determined as visual analog scale (VAS) scores at rest coughing, secondary observation outcomes time use analgesic pump, total consumption oxycodone number effective pump compressions 48 h postoperatively, perioperative sufentanil, extubation, hospital length stay, urine volume, incidence adverse events. Results state cough, Group TP showed significantly lower VAS pain 1, 12, 24, postoperative-hour compared C T. Intraoperative sufentanil consumption, press times patient- (PCA) than those Interestingly, output higher TP. There differences between groups terms extubation time, stay effects, indicating that intravenous is an safe method. Conclusions may provide important beneficial effects on acute control reduce opioid undergoing VATS. Trial registration The trial registered Jun 19, 2023 Chinese Clinical Registry ( https://www.chictr.org.cn/showproj.html?proj=199315 ), ChiCTR2300072623 (19/06/2023).

Язык: Английский

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Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study

BMC Cancer, Год журнала: 2021, Номер 21(1)

Опубликована: Ноя. 16, 2021

Abstract Background The optimal modality for postoperative analgesia after uniportal video-assisted thoracoscopic surgery (UVATS) the treatment of lung cancer has not yet been determined. Both ultrasound-guided paravertebral block (PVB) and retrolaminar (RLB) have reported to be successful in providing UVATS. However, which technique provides superior UVATS is still unclear. This randomized study was designed compare analgesic effects adverse events associated with PVB RLB Methods Sixty patients were undergo (group P) or R). In group P, 30 mL 0.5% ropivacaine injected at T3 T5 levels via (15 each level on operative side). R, primary outcome numerical rating scale (NRS) score within 48 h surgery. secondary outcomes total sufentanil consumption, time first request events. Results At 3, 6, 12, 24, 36 postoperatively, NRS rest P lower than that R ( p < 0.05). 24 while coughing consumption significantly 0.001). Additionally, longer 0.0001). incidence nausea higher Conclusions undergoing UVATS, better results less RLB. Compared RLB, seems a Trial registration name this Effect And Mechanism Of Ultrasound-guided Multimodal Regional Nerve Block On Acute Chronic Pain After Thoracic Surgery. registered Chinese Clinical Registry ChiCTR2100044060 ). date March 9, 2021.

Язык: Английский

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Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Videosurgery and Other Miniinvasive Techniques, Год журнала: 2023, Номер unknown, С. 52 - 68

Опубликована: Янв. 23, 2023

Nerve block is widely used for pain management after video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral (TPVB), erector spinae plane (ESPB), serratus anterior (SAPB), and intercostal nerve (ICNB) are alternative treatments.Network meta-analysis based on Bayesian analyses was performed to obtain results direct comparison, indirect network make rankings probabilities. Covariates were adjusted determine the effect of covariates this study.The study identified 61 randomized controlled trials (RCTs) (4468 patients). There probability ranking first ("best" treatment): 24 h morphine consumption, TPVB > ESPB ICNB SAPB. Covariate adjustment allowed four treatments change somewhat in likelihood best choice.TPVB ranks our analysis. a viable alternative. SAPB seem play limited role postoperative management.

Язык: Английский

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Comparative analysis of the analgesic effects of intercostal nerve block, ultrasound-guided paravertebral nerve block, and epidural block following single-port thoracoscopic lung surgery

Journal of Cardiothoracic Surgery, Год журнала: 2024, Номер 19(1)

Опубликована: Июль 1, 2024

In this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral (PVB), and epidural (EB) following single-port thoracoscopic lung surgery.

Язык: Английский

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