Best pain management after video-assisted thoracoscopic surgery: A best evidence topic report

A best evidence topic in thoracic surgery was written according to a structured protocol. The clinical question addressed was: "What is the best pain management after video-assisted thoracoscopic surgery (VATS)"? The literature search identified a total of 485 papers, of which 10 studies were selected as providing the strongest evidence to answer the clinical question. These included 4 meta-analyses, 6 randomized controlled trials. The selected studies are presented in tabular form, summarizing the author, year of publication, journal, country of origin, study design, patient population, relevant outcomes, and key findings. Serratus anterior plane block has emerged as a promising analgesic method for VATS, demonstrating effectiveness in relieving postoperative pain, reducing opioid consumption, and decreasing the incidence of postoperative nausea and vomiting. Thoracic epidural analgesia, although historically regarded as the gold standard for pain management, does not demonstrate a clear superiority based on current evidence. Thoracic paravertebral block is considered a superior regional analgesic option in thoracic surgery, and its combination with other techniques may further enhance postoperative pain control after VATS. Additionally, intravenous dexamethasone, when added to VATS protocols, may reduce opioid consumption and promote early mobilization.