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. 2023 Jan 4;36(1):ivad003.
doi: 10.1093/icvts/ivad003.

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

Louisa N Spaans  1 , Jelle E Bousema  1 , Patrick Meijer  2 , R A Arthur Bouwman  3 , Renee van den Broek  3 , Jo Mourisse  4 , Marcel G W Dijkgraaf  5 , Ad F T M Verhagen  6 , Frank J C van den Broek  1
Affiliations

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

Louisa N Spaans et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding postoperative analgesia. We performed a systematic review and meta-analysis to determine the mean pain scores of different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia and only systemic analgesia) after thoracoscopic anatomical lung resection.

Methods: Medline, Embase and Cochrane databases were searched until 1 October 2022. Patients undergoing at least >70% anatomical resections through thoracoscopy reporting postoperative pain scores were included. Due to a high inter-study variability an explorative meta-analysis next to an analytic meta-analysis was performed. The quality of evidence has been evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.

Results: A total of 51 studies comprising 5573 patients were included. Mean 24, 48 and 72 h pain scores with 95% confidence interval on a 0-10 scale were calculated. Length of hospital stay, postoperative nausea and vomiting, additional opioids and the use of rescue analgesia were analysed as secondary outcomes. A common-effect size was estimated with an extreme high heterogeneity for which pooling of the studies was not appropriate. An exploratory meta-analysis demonstrated acceptable mean pain scores of Numeric Rating Scale <4 for all analgesic techniques.

Conclusions: This extensive literature review and attempt to pool mean pain scores for meta-analysis demonstrates that unilateral regional analgesia is gaining popularity over thoracic epidural analgesia in thoracoscopic anatomical lung resection, despite great heterogeneity and limitations of current studies precluding such recommendations.

Prospero registration: ID number 205311.

Keywords: Acute postoperative pain; Anatomic lung resection; Health economics; Intercostal analgesia; Pain management; Regional analgesia; Thoracic epidural analgesia; Video-assisted thoracic surgery.

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Figures

Figure 1:
Figure 1:
Flow diagram of study selection (n = number).
Figure 2:
Figure 2:
Meta-analysis of mean (standard deviation) pain scores 24, 48 and 72 h after video-assisted thoracoscopic surgery anatomical lung resection. (A) Thoracic epidural analgesia. (B) Continuous regional analgesia. (C) Single-shot regional analgesia. (D) Systemic analgesia. 95% CI: 95% confidence interval; n: total number of patients; SD: standard deviation.
Figure 2:
Figure 2:
Meta-analysis of mean (standard deviation) pain scores 24, 48 and 72 h after video-assisted thoracoscopic surgery anatomical lung resection. (A) Thoracic epidural analgesia. (B) Continuous regional analgesia. (C) Single-shot regional analgesia. (D) Systemic analgesia. 95% CI: 95% confidence interval; n: total number of patients; SD: standard deviation.
Figure 2:
Figure 2:
Meta-analysis of mean (standard deviation) pain scores 24, 48 and 72 h after video-assisted thoracoscopic surgery anatomical lung resection. (A) Thoracic epidural analgesia. (B) Continuous regional analgesia. (C) Single-shot regional analgesia. (D) Systemic analgesia. 95% CI: 95% confidence interval; n: total number of patients; SD: standard deviation.
None
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