This review was performed in accordance with the PROSPECT methodology [6 (link), 7 , 8 (link)]. Specific to this study, the Embase; MEDLINE; PubMed; Cochrane Central Register of Controlled Trials; Cochrane Database of Abstracts of Reviews of Effects; and Cochrane Database of Systematic Reviews were searched for randomised controlled trials published between 01 January 2010 and 01 January 2021. We focused on this time period because VATS was uncommonly performed for lung resection in the preceding years, with thoracotomy being the standard of care at that time.
Search terms used were related to pain and interventions for VATS. These comprised ‘video‐assisted thoracoscopic surgery’ and/or ‘thoracoscopic’ and/or ‘video‐assisted wedge’ and/or ‘video‐assisted lobectomy’ and/or ‘pain’ and/or ‘analgesia’ and/or ‘anaesthesia’ and/or ‘anesthetic’ and/or ‘visual analogue’ and/or ‘vrs’ and/or ‘mcgill’ and/or ‘epidural’ and/or ‘neuraxial’ and/or ‘spinal’ and/or ‘paravertebral block’ and/or ‘erector spinae’ and/or ‘serratus block’ and/or ‘intercostal block’ and/or ‘suprascapular block’ and/or ‘intrathecal’ and/or ‘caudal’ and/or ‘intrapleural’ and/or ‘narcotic’ and/or ‘continuous intercostal nerve block’ and/or ‘combined epidural‐general’ and/or ‘combined regional‐general’ and/or ‘NMDA’ and/or ‘peripheral block’ and/or ‘infiltration’ or ‘instillation’ or ‘NSAID’ or ‘COX‐2’ or ‘paracetamol’ or ‘acetaminophen’ or ‘gabapentin’ or ‘pregabalin’ or ‘clonidine’ or ‘opioid’ or ‘ketamine’ or ‘corticosteroid’ or ‘dexamethasone’ or ‘magnesium’ or ‘lidocaine’ or ‘patient‐controlled analgesia’ or ‘PCA’ or ‘PEC block’ or ‘transcutaneous electrical nerve stimulation’ and/or ‘TENS’.
We included randomised controlled trials and systematic reviews published in English assessing pain management for patients undergoing VATS for lung resection. We excluded studies with patients who underwent a thoracotomy and studies in which more than 75% of the included patients underwent surgery for pneumothorax, as the peri‐operative pain profiles varied from VATS for lung resection. These studies were removed from analysis because pleural abrasion or resection prevents the use of some regional anaesthetic techniques such as paravertebral block. Pain control after pneumothorax surgery is an issue that is somewhat different from pain control after lung resection, and the aim of PROSPECT review being to provide clinicians appropriate recommendations applying specifically for dedicated surgical procedures.
Quality assessment, data extraction and data analysis adhered to the PROSPECT methodology [7 ]. The studies were required to measure pain intensity using a visual analogue scale (VAS) or a numeral rating scale (NRS). We defined a change of more than 10 on a scale of 0–100 as clinically relevant. We used the PROSPECT methodology previously described for the assessment of the study protocols and results [9 (link)]. A p value of <0.05 was considered to be statistically significant, and if two or more studies achieved a significant difference, we considered there to be enough data to recommend the treatment or the technique.
Recommendations were made according to the PROSPECT methodology [9 (link)]. Criteria for the assessment of the quality of eligible studies included allocation concealment (A, adequate; B, unclear; C, inadequate; D, not used), numerical (1–5) quality scoring system used by Jadad et al. to assess randomisation, blinding and flow of patients; follow‐up of more or less than 80% of the included patients; and whether the study met the requirements of the CONSORT 2010 statement. The suggested recommendations were sent to the PROSPECT Working Group for review and comments through a modified Delphi approach as previously described [9 (link)]. Once consensus was achieved, the lead authors drafted the final document, which was ultimately approved by the Working Group.
Search terms used were related to pain and interventions for VATS. These comprised ‘video‐assisted thoracoscopic surgery’ and/or ‘thoracoscopic’ and/or ‘video‐assisted wedge’ and/or ‘video‐assisted lobectomy’ and/or ‘pain’ and/or ‘analgesia’ and/or ‘anaesthesia’ and/or ‘anesthetic’ and/or ‘visual analogue’ and/or ‘vrs’ and/or ‘mcgill’ and/or ‘epidural’ and/or ‘neuraxial’ and/or ‘spinal’ and/or ‘paravertebral block’ and/or ‘erector spinae’ and/or ‘serratus block’ and/or ‘intercostal block’ and/or ‘suprascapular block’ and/or ‘intrathecal’ and/or ‘caudal’ and/or ‘intrapleural’ and/or ‘narcotic’ and/or ‘continuous intercostal nerve block’ and/or ‘combined epidural‐general’ and/or ‘combined regional‐general’ and/or ‘NMDA’ and/or ‘peripheral block’ and/or ‘infiltration’ or ‘instillation’ or ‘NSAID’ or ‘COX‐2’ or ‘paracetamol’ or ‘acetaminophen’ or ‘gabapentin’ or ‘pregabalin’ or ‘clonidine’ or ‘opioid’ or ‘ketamine’ or ‘corticosteroid’ or ‘dexamethasone’ or ‘magnesium’ or ‘lidocaine’ or ‘patient‐controlled analgesia’ or ‘PCA’ or ‘PEC block’ or ‘transcutaneous electrical nerve stimulation’ and/or ‘TENS’.
We included randomised controlled trials and systematic reviews published in English assessing pain management for patients undergoing VATS for lung resection. We excluded studies with patients who underwent a thoracotomy and studies in which more than 75% of the included patients underwent surgery for pneumothorax, as the peri‐operative pain profiles varied from VATS for lung resection. These studies were removed from analysis because pleural abrasion or resection prevents the use of some regional anaesthetic techniques such as paravertebral block. Pain control after pneumothorax surgery is an issue that is somewhat different from pain control after lung resection, and the aim of PROSPECT review being to provide clinicians appropriate recommendations applying specifically for dedicated surgical procedures.
Quality assessment, data extraction and data analysis adhered to the PROSPECT methodology [7 ]. The studies were required to measure pain intensity using a visual analogue scale (VAS) or a numeral rating scale (NRS). We defined a change of more than 10 on a scale of 0–100 as clinically relevant. We used the PROSPECT methodology previously described for the assessment of the study protocols and results [9 (link)]. A p value of <0.05 was considered to be statistically significant, and if two or more studies achieved a significant difference, we considered there to be enough data to recommend the treatment or the technique.
Recommendations were made according to the PROSPECT methodology [9 (link)]. Criteria for the assessment of the quality of eligible studies included allocation concealment (A, adequate; B, unclear; C, inadequate; D, not used), numerical (1–5) quality scoring system used by Jadad et al. to assess randomisation, blinding and flow of patients; follow‐up of more or less than 80% of the included patients; and whether the study met the requirements of the CONSORT 2010 statement. The suggested recommendations were sent to the PROSPECT Working Group for review and comments through a modified Delphi approach as previously described [9 (link)]. Once consensus was achieved, the lead authors drafted the final document, which was ultimately approved by the Working Group.
