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

Evidence summary on pain management in thoracoscopic lung cancer surgery

Objective

The study aimed to systematically retrieve, evaluate and summarize evidence on perioperative pain management in adults undergoing thoracoscopic lung cancer surgery, to assist oncology nurses in improving pain assessment and management.

Methods

The research question was established using PIPOST model and a systematic search was conducted in English and Chinese databases, professional society websites and guideline platforms for literature published between January 2017 and December 2024. Included literature types comprised guidelines, systematic reviews, evidence summaries, expert consensus, and standards. After literature searching and screening in January 2025, the remaining guidelines were evaluated by four investigators, while other literature was assessed by two investigators. Evidence was then extracted and graded.

Results

Eighteen articles were included, comprising 5 systematic reviews, 3 guidelines, 2 clinical decisions, 4 evidence summaries, 3 expert consensus, and 1 standard. Twenty-five pieces of evidence across six topics were summarized, covering organizational management, high-risk patient assessment and preoperative education, pain assessment, intraoperative analgesia, multimodal pharmacological strategies, and non-pharmacological interventions.

Conclusions

This evidence summary highlights effective strategies for perioperative pain management in thoracoscopic lung cancer surgery, which could support oncology nurses in implementing comprehensive pain assessment, identifying high-risk patients, and applying diversified analgesic interventions.

Continuous erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracoscopic surgery: a prospective randomized open-label non-inferiority trial

BACKGROUND AND OBJECTIVES

The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery.

METHODS

We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization.

RESULTS

Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2.

CONCLUSIONS

The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery.

TRIAL REGISTRATION NUMBER

Dutch Trial Register (NL6433).

Efficacy of Intravenous Administration of Esketamine in Preventing and Treating Rebound Pain After Thoracic Paravertebral Nerve Block: A Prospective Randomized, Double-Blind, Placebo-Controlled Trial

Purpose

Investigating the efficacy of intraoperative fractionated intravenous esketamine in the prevention of rebound pain after cessation of thoracic paravertebral nerve blockade.

Methods

One hundred and twenty patients who underwent elective thoracoscopic lobectomy were selected for the study and were randomly divided into two groups, the esketamine group was given 0.5 mg/kg and 0.3 mg/kg of esketamine at the induction of anaesthesia and 30 minutes before the end of the operation, respectively, and the control group was given an equal amount of saline. The incidence of rebound pain (RP) 7 days after surgery and postoperative recovery were compared between the two groups.

Results

The NRS pain scores at 24 and 48 hours postoperatively in the esketamine group were significantly lower than those in the control group (P < 0.05). The incidence of postoperative rebound pain was significantly lower in the esketamine group than in the control group (P < 0.05). The consumption of sufentanil was less in the esketamine group in the postoperative 48 hours (P < 0.05). Postoperative recovery was compared between the two groups and the difference was not statistically significant.

Conclusion

Intravenous esketamine reduces postoperative pain scores, decreases the incidence of rebound pain after cessation of thoracic paravertebral block, and reduces opioid consumption.