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

中文翻译：

---

电视胸腔镜手术前景指南：系统评价和针对特定手术的术后疼痛管理建议

与开胸手术相比，视频辅助胸腔镜手术由于恢复时间更快、术后疼痛减轻而越来越受欢迎。然而，电视胸腔镜手术的镇痛方案差异很大。本系统评价的目的是评估现有文献，并为电视胸腔镜手术后的最佳疼痛管理提出建议。使用特定程序的术后疼痛管理 (PROSPECT) 方法进行了系统评价。确定了 2010 年 1 月至 2021 年 1 月期间以英语发表的随机对照试验，评估镇痛、麻醉或手术干预的效果。我们检索了 1070 项研究，其中 69 项随机对照试验和两项评价符合纳入标准。我们建议在术前或术中使用基础镇痛药，包括对乙酰氨基酚和非甾体抗炎药或环氧合酶 2 特异性抑制剂，并在术后继续使用。可以使用术中静脉输注右美托咪定，特别是当不能给予基本镇痛和局部镇痛技术时。此外，建议首选椎旁阻滞或竖脊肌平面阻滞。前锯肌平面阻滞也可以作为第二选择。术后应保留阿片类药物作为抢救镇痛药。可以使用术中静脉输注右美托咪定，特别是当不能给予基本镇痛和局部镇痛技术时。此外，建议首选椎旁阻滞或竖脊肌平面阻滞。前锯肌平面阻滞也可以作为第二选择。术后应保留阿片类药物作为抢救镇痛药。可以使用术中静脉输注右美托咪定，特别是当不能给予基本镇痛和局部镇痛技术时。此外，建议首选椎旁阻滞或竖脊肌平面阻滞。前锯肌平面阻滞也可以作为第二选择。术后应保留阿片类药物作为抢救镇痛药。