Regional analgesia for video-assisted thoracic surgery: a systematic review

被引:127
作者
Steinthorsdottir, Kristin Julia [1 ]
Wildgaard, Lorna [2 ]
Hansen, Henrik Jessen [1 ]
Petersen, Rene Horsleben [1 ]
Wildgaard, Kim [3 ]
机构
[1] Univ Copenhagen, Rigshosp, Dept Cardiothorac Surg, DK-2100 Copenhagen, Denmark
[2] Univ Copenhagen, Royal Sch Lib & Informat Sci, Copenhagen, Denmark
[3] Univ Copenhagen, Rigshosp, Sect Surg Pathophysiol, DK-2100 Copenhagen, Denmark
关键词
Pain; Postoperative; Regional analgesia; Thoracoscopic; VATS; Video-assisted thoracic surgery; THORACOSCOPIC SURGERY; POSTOPERATIVE PAIN; PARAVERTEBRAL BLOCK; PULMONARY-FUNCTION; SINGLE-INJECTION; LOBECTOMY; RESECTION; EFFICACY; OUTCOMES; TRIALS;
D O I
10.1093/ejcts/ezt525
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncological lung surgery. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are established analgesic golden standards for open surgery such as thoracotomy; however, there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques with regard to effect on acute postoperative pain following VATS, with emphasis on VATS lobectomy. The systematic review of PubMed, The Cochrane Library and Embase databases yielded 1542 unique abstracts; 17 articles were included for qualitative assessment, of which three were studies on VATS lobectomy. The analgesic techniques included TEA, multilevel and single PVB, paravertebral catheter, intercostal catheter, interpleural infusion and long thoracic nerve block. Overall, the studies were heterogeneous with small numbers of participants. In comparative studies, TEA and especially PVB showed some effect on pain scores, but were often compared with an inferior analgesic treatment. Other techniques showed no unequivocal results. No clear gold standard for regional analgesia for VATS could be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS is presented.
引用
收藏
页码:959 / 966
页数:8
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