【原】【罂粟摘要】硬膜外镇痛与全身阿片类药物治疗VATS术后疼痛管理：系统回顾方案

硬膜外镇痛与全身阿片类药物治疗VATS术后疼痛管理：系统回顾方案

贵州医科大学    麻醉与心脏电生理课题组

翻译：文春雷    编辑：王波          审校：曹莹

背景

视频辅助胸腔镜手术（VATS）后的术后疼痛仍然是一个重大挑战。虽然硬膜外镇痛仍然是金标准，但由于被认为并发症风险较低，其他类型的区域性镇痛正在逐渐受到欢迎。全身性阿片类药物作为硬膜外镇痛的替代方案的有效性尚未得到充分探讨。本系统评价和荟萃分析旨在评估和比较全身阿片类药物与硬膜外镇痛在VATS术后疼痛管理中的有效性。

方法

我们将根据Cochrane手册和系统评价与荟萃分析协议的优先报告项目（PRISMA-P）清单进行系统评价和荟萃分析。将在MEDLINE、EMBASE和Cochrane图书馆进行全面检索，并补充Scopus引文检索、使用Google Scholar检索灰色文献以及进行正在进行的研究检索。我们将根据PICO方法纳入研究，不限制研究类型。两名独立评审员将筛选研究、提取数据，并使用Cochrane偏倚风险工具评估研究质量。主要结果将包括术后24、48和72小时的静息和活动时疼痛强度。次要结果将包括“补救”阿片类药物的使用、住院时间和不良事件。如果可行，将进行荟萃分析，否则将进行描述性分析。

结果

结果将提供全身性阿片类药物与硬膜外镇痛在VATS患者术后疼痛管理中的有效性比较分析。数据综合将包括疼痛评分、阿片类药物消耗和不良事件的汇总估计，可能还会进行亚组和敏感性分析，以探讨研究之间的异质性。

结论

      这项系统评价将为接受胸腔镜手术的患者提供有关最佳疼痛管理策略的宝贵见解。研究结果可能会指导临床实践，帮助选择最有效和安全的镇痛方法，从而改善术后恢复和患者的治疗效果。

原始文献来源：AJimmy H. Holm, Mikkel Bak, Anne C. Brøchner. Epidural analgesia versus systemic opioids for postoperative pain management after VATS: Protocol for a systematic review.[J]. Acta Anaesthesiol Scand. 2025 ;69(1):e14546.

Epidural analgesia versus systemic opioids for postoperative pain management after VATS: Protocol for a systematic review

Background: Postoperative pain following video-assisted thoracoscopic surgery (VATS) remains a significant challenge. While epidural analgesia is still the gold standard, other types of regional analgesia are gaining popularity because of perceived less risk of complications. The efficacy of systemic opioids as an alternative to epidural analgesia has not been thoroughly explored. This systematic review and metaanalysis aims to evaluate and compare the efficacy of systemic opioids versus epidural analgesia in managing postoperative pain after VATS.

Methods: We will conduct a systematic review and meta-analysis in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. A comprehensive search will be conducted in MEDLINE, EMBASE, and the Cochrane Library supplemented with Scopus citation searches, search for gray literature using Google Scholar and a search for ongoing studies. We will include studies based on the PICO methodology without restrictions regarding study type. Two independent reviewers will screen studies, extract data, and assess study quality using the Cochrane Risk of Bias tools. The primary outcomes will be postoperative pain intensity at rest and during activity at

24, 48, and 72 h. Secondary outcomes will include use of “rescue” opioids, hospital length of stay, and adverse events. If feasible, a meta-analysis will be done, otherwise we will perform a descriptive analysis.

Results: The results will provide a comparative analysis of the effectiveness of systemic opioids versus epidural analgesia in managing postoperative pain in VATS patients. Data synthesis will include pooled estimates for pain scores, opioid consumption, and adverse events, possibly with subgroup and sensitivity analyses conducted to explore heterogeneity across studies.

Conclusions: This systematic review will offer valuable insights into the optimal pain management strategy for patients undergoing VATS. The findings may guide clinical practice in selecting the most effective and safe analgesic approach, improving postoperative recovery, and patient outcomes.

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