Introduction

A best evidence topic was structured following ICVTS protocol guidelines.
Postoperative pain management remains crucial for patient recovery and quality of life after thoracic surgery.

Three-Part Question

What is the gold standard technique for postoperative pain management in patients undergoing video- assisted thoracoscopic surgery (VATS)?

Clinical Scenario

A 62-year-old male scheduled for VATS lobectomy, previously experienced severe thoracotomy pain. Pain control options include TEA (traditional gold standard), TPVB, ESPB, SAPB, intercostal nerve blocks, opioids, and NSAIDs.
A literature review was initiated to determine the optimal pain management strategy for VATS.

Search Strategy

Databases: PubMed and Medline (2014–2024).
MeSH terms: Thoracic Surgery, Video-Assisted, VATS, pain management, postoperative pain, gold standard.
Inclusion:Studies focusing solely on VATS,

Why This Question Is Important

Postoperative pain can impair recovery, daily functioning, mental health, and overall quality of life. Chronic pain increases healthcare costs and can diminish patient satisfaction after life-saving surgeries.
Effective pain management is critical, particularly in the era of minimally invasive surgery.

This review seeks to identify the most effective and evidence-based strategy for pain control following VATS.

Clinical Bottom Line

Tailored regional anesthesia techniques significantly improve postoperative pain management and recovery after VATS.
TPVB stands out as the most effective method.
ESPB and SAPB are also viable alternatives.

Combining techniques with adjuncts such as intravenous dexamethasone and lidocaine may further optimize pain management strategies.

RCT: Randomized controlled trial, Pt.: Patient, VATS: Video-assisted thoracoscopic surgery, PONV: Postoperative nausea and vomiting, SAPB: Serratus anterior plane block, TEA: Thoracic epidural