1 Det Kgl. Bibliotek - Universitetsbibliotekarens ledelsessekretariat, Eksterne centre, Københavns Universitet2 Det Informationsvidenskabelige Akademi - Ledelse og sekretariat, Royal School of Library and Information Science, Faculty of Humanities, Københavns Universitet3 Royal School of Library and Information Science, Faculty of Humanities, Københavns Universitet4 Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University, Copenhagen,5 Det Informationsvidenskabelige Akademi - Forskning, Royal School of Library and Information Science, Faculty of Humanities, Københavns Universitet6 Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University, Copenhagen7 Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen8 Det Informationsvidenskabelige Akademi - Forskning, Royal School of Library and Information Science, Faculty of Humanities, Københavns Universitet
a systematic review
Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncologic 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 in regards to effect on acute post-operative pain following VATS, with emphasis on VATS lobectomy. The systematic review of the PubMed, Cochrane Library and Embase databases yielded unique 1542 abstracts, 17 articles were included for qualitative assessment, of which 3 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 to 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.
European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 2013, Vol 45, Issue 6, p. 959-966
The Faculty of Health Science; Pain; post-operative; regional analgesia; thoracoscopic, VATS, Video-assisted thoracic surgery