PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations

S Feray, J Lubach, G P Joshi, F Bonnet, M Van de Velde, PROSPECT Working Group *of the European Society of Regional Anaesthesia and Pain Therapy, G P Joshi, E Pogatzki-Zahn, M Van de Velde, S Schug, H Kehlet, F Bonnet, N Rawal, A Delbos, P Lavand'homme, H Beloeil, J Raeder, A Sauter, E Albrecht, P Lirk, D Lobo, S Frey, S Feray, J Lubach, G P Joshi, F Bonnet, M Van de Velde, PROSPECT Working Group *of the European Society of Regional Anaesthesia and Pain Therapy, G P Joshi, E Pogatzki-Zahn, M Van de Velde, S Schug, H Kehlet, F Bonnet, N Rawal, A Delbos, P Lavand'homme, H Beloeil, J Raeder, A Sauter, E Albrecht, P Lirk, D Lobo, S Frey

Abstract

Video-assisted thoracoscopic surgery has become increasingly popular due to faster recovery times and reduced postoperative pain compared with thoracotomy. However, analgesic regimens for video-assisted thoracoscopic surgery vary significantly. The goal of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after video-assisted thoracoscopic surgery. A systematic review was undertaken using procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials published in the English language, between January 2010 and January 2021 assessing the effect of analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies of which 69 randomised controlled trials and two reviews met inclusion criteria. We recommend the administration of basic analgesia including paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2-specific inhibitors pre-operatively or intra-operatively and continued postoperatively. Intra-operative intravenous dexmedetomidine infusion may be used, specifically when basic analgesia and regional analgesic techniques could not be given. In addition, a paravertebral block or erector spinae plane block is recommended as a first-choice option. A serratus anterior plane block could also be administered as a second-choice option. Opioids should be reserved as rescue analgesics in the postoperative period.

Keywords: analgesia; evidence-based medicine; postoperative pain; systematic review; video-assisted thoracoscopic surgery.

© 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

Figures

Figure 1
Figure 1
Flow diagram of studies identified, screened and included in this systematic review.

References

    1. Holbek BL, Horsleben Petersen R, Kehlet H, Hansen HJ. Fast‐track video‐assisted thoracoscopic surgery: future challenges. Scandinavian Cardiovascular Journal 2016; 50: 78–82.
    1. Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video‐assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncology 2016; 17: 836–44.
    1. Piccioni F, Segat M, Falini S, et al. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols. Journal of Thoracic Disease 2018; 10: S555–63.
    1. Batchelor TJP, Rasburn NJ, Abdelnour‐Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). European Journal of Cardio‐Thoracic Surgery 2019; 55: 91–115.
    1. Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesthesia and Analgesia 2008; 107: 1026–40.
    1. Joshi GP, Schug SA, Kehlet H. Procedure‐specific pain management and outcome strategies. Best Practice and Research Clinical Anaesthesiology 2014; 28: 191–201.
    1. Joshi GP, Kehlet H, Beloeil H, et al. PROSPECT Working Group. Guidelines for perioperative pain management: need for re‐evaluation. British Journal of Anaesthesia 2017; 119: 703–6.
    1. Lee B, Schug SA, Joshi GP, et al. PROSPECT Working Group . Procedure‐specific pain management (PROSPECT) – an update. Best Practice and Research Clinical Anaesthesiology 2018; 32: 101–11.
    1. Joshi GP, Van de Velde M, Kehlet H, et al. PROSPECT Working Group Collaborators . Development of evidence‐based recommendations for procedure‐specific pain management: PROSPECT methodology. Anaesthesia 2019; 74: 1298–304.
    1. Jahangiri Fard A, Farzanegan B, Khalili A, et al. Paracetamol instead of ketorolac in post‐video‐assisted thoracic surgery pain management: a randomized trial. Anesthesiology and Pain Medicine 2016; 6: e39175.
    1. Dastan F, Langari ZM, Salamzadeh J, Khalili A, Aqajani S, Jahangirifard A. A comparative study of the analgesic effects of intravenous ketorolac, paracetamol, and morphine in patients undergoing video‐assisted thoracoscopic surgery: a double‐blind, active‐controlled, randomized clinical trial. Annals of Cardiac Anaesthesia 2020; 23: 177–82.
    1. Lee SH, Lee CY, Lee JG, Kim N, Lee HM, Oh YJ. Intraoperative dexmedetomidine improves the quality of recovery and postoperative pulmonary function in patients undergoing video‐assisted thoracoscopic surgery. Medicine 2016; 95: e2854.
    1. Jannu V, Dhorigol MG. Effect of Intraoperative Dexmedetomidine on postoperative pain and pulmonary function following video‐assisted thoracoscopic surgery. Anesthesia: Essays and Researches 2020; 14: 68–71.
    1. Kweon D‐E, Koo Y, Lee S, Chung K, Ahn S, Park C. Postoperative infusion of a low dose of dexmedetomidine reduces intravenous consumption of sufentanil in patient‐controlled analgesia. Korean Journal of Anesthesiology 2018; 71: 226–31.
    1. Miao Z, Wu P, Wang J, et al. Whole‐course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia for patients with lung cancer undergoing thoracoscopic surgery: a randomized control trial. Pain Physician 2020; 23: E185–93.
    1. Wang X, Wang K, Wang B, et al. Effect of oxycodone combined with dexmedetomidine for intravenous patient‐controlled analgesia after video‐assisted thoracoscopic lobectomy. Journal of Cardiothoracic and Vascular Anesthesia 2016; 30: 1015–21.
    1. Bai Y, Sun K, Xing X, et al. Postoperative analgesic effect of hydromorphone in patients undergoing single‐port video‐assisted thoracoscopic surgery: a randomized controlled trial. Journal of Pain Research 2019; 12: 1091–101.
    1. Bjerregaard LS, Jensen PF, Bigler DR, et al. High‐dose methylprednisolone in video‐assisted thoracoscopic surgery lobectomy: a randomized controlled trial. European Journal of Cardio‐Thoracic Surgery 2018; 53: 209–15.
    1. Sohn H‐M, Jheon S‐H, Nam S, Do S‐H. Magnesium sulphate improves pulmonary function after video‐assisted thoracoscopic surgery: a randomised double‐blind placebo‐controlled study. European Journal of Anaesthesiology 2017; 34: 508–14.
    1. Kim JC, Byun S, Kim S, Lee S‐Y, Lee JH, Ahn S. Effect of preoperative pregabalin as an adjunct to a multimodal analgesic regimen in video‐assisted thoracoscopic surgery: a randomized controlled trial. Medicine 2017; 96: e8644.
    1. Konstantatos AH, Howard W, Story D, Mok LYH, Boyd D, Chan MTV. A randomised controlled trial of peri‐operative pregabalin vs. placebo for video‐assisted thoracoscopic surgery. Anaesthesia 2016; 71: 192–7.
    1. Homma T, Doki Y, Yamamoto Y, et al. Efficacy of 50 mg pregabalin for prevention of postoperative neuropathic pain after video‐assisted thoracoscopic surgery and thoracotomy: a 3‐month prospective randomized controlled trial. Journal of Thoracic Disease 2019; 11: 694–701.
    1. Slovack M, Taylor B, Bryce R, Ong D. Does intravenous lidocaine infusion during video‐assisted thoracoscopic surgery reduce postoperative analgesia? A randomized controlled study. Canadian Journal of Anesthesia 2015; 62: 676–7.
    1. Engen DJ, Carns PE, Allen MS, et al. Evaluating efficacy and feasibility of transcutaneous electrical nerve stimulation for postoperative pain after video‐assisted thoracoscopic surgery: a randomized pilot trial. Complementary Therapies in Clinical Practice 2016; 23: 141–8.
    1. Chen J, Zhang Y, Li X, et al. Efficacy of transcutaneous electrical acupoint stimulation combined with general anesthesia for sedation and postoperative analgesia in minimally invasive lung cancer surgery: a randomized, double‐blind, placebo‐controlled trial. Thoracic Cancer 2020; 11: 928–34.
    1. Giang NT, Van Nam N, Trung NN, et al. Patient‐controlled paravertebral analgesia for video‐assisted thoracoscopic surgery lobectomy. Local and Regional Anesthesia 2018; 11: 115–21.
    1. Lee CY, Narm KS, Lee JG, et al. A prospective randomized trial of continuous paravertebral infusion versus intravenous patient‐controlled analgesia after thoracoscopic lobectomy for lung cancer. Journal of Thoracic Disease 2018; 10: 3814–23.
    1. Wu Z, Fang S, Wang Q, Wu C, Zhan T, Wu M. Patient‐controlled paravertebral block for video‐assisted thoracic surgery: a randomized Trial. Annals of Thoracic Surgery 2018; 106: 888–94.
    1. Zhang X, Shu L, Lin C, et al. Comparison between intraoperative two‐space injection thoracic paravertebral block and wound infiltration as a component of multimodal analgesia for postoperative pain management after video‐assisted thoracoscopic lobectomy: a randomized controlled trial. Journal of Cardiothoracic and Vascular Anesthesia 2015; 29: 1550–6.
    1. Chu H, Dong H, Wang Y, Niu Z. Effects of ultrasound‐guided paravertebral block on MMP‐9 and postoperative pain in patients undergoing VATS lobectomy: a randomized, controlled clinical trial. BMC Anesthesiology 2020; 20: 59.
    1. Chu L, Zhang X, Lu Y, et al. Improved analgesic effect of paravertebral blocks before and after video‐assisted thoracic surgery: a prospective, double‐blinded, randomized controlled trial. Pain Research and Management 2019; 2019: 9158653.
    1. Kang K, Meng X, Li B, et al. Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery. World Journal of Surgical Oncology 2020; 18: 298.
    1. Hutchins J, Sanchez J, Andrade R, Podgaetz E, Wang Q, Sikka R. Ultrasound‐guided paravertebral catheter versus intercostal blocks for postoperative pain control in video‐assisted thoracoscopic surgery: a prospective randomized trial. Journal of Cardiothoracic and Vascular Anesthesia 2017; 31: 458–63.
    1. Kadomatsu Y, Mori S, Ueno H, Uchiyama M, Wakai K. Comparison of the analgesic effects of modified continuous intercostal block and paravertebral block under surgeon’s direct vision after video‐assisted thoracic surgery: a randomized clinical trial. General Thoracic and Cardiovascular Surgery 2018; 66: 425–31.
    1. Xu J, Yang X, Hu X, Chen X, Zhang J, Wang Y. Multilevel thoracic paravertebral block using ropivacaine with/without dexmedetomidine in video‐assisted thoracoscopic surgery. Journal of Cardiothoracic and Vascular Anesthesia 2018; 32: 318–24.
    1. Hong B, Lim C, Kang H, et al. Thoracic paravertebral block with adjuvant dexmedetomidine in video‐assisted thoracoscopic surgery: a randomized, double‐blind study. Journal of Clinical Medicine 2019; 8: 352.
    1. Abd‐Elshafy SK, Abdallal F, Kamel EZ, et al. Paravertebral dexmedetomidine in video‐assisted thoracic surgeries for acute and chronic pain prevention. Pain Physician 2019; 22: 271–80.
    1. Ding W, Chen Y, Li D, et al. Investigation of single‐dose thoracic paravertebral analgesia for postoperative pain control after thoracoscopic lobectomy – a randomized controlled trial. International Journal of Surgery 2018; 57: 8–14.
    1. Taketa Y, Irisawa Y, Fujitani T. Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound‐guided thoracic paravertebral block for video‐assisted thoracoscopic surgery: a randomised controlled trial. European Journal of Anaesthesiology 2019; 36: 272–8.
    1. Chen L, Wu Y, Cai Y, et al. Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient‐controlled analgesia with thoracic paravertebral block catheter: a randomized, double‐blind, controlled trial. Regional Anesthesia and Pain Medicine 2019; 44: 240–5.
    1. Kamalanathan K, Knight T, Rasburn N, Joshi N, Molyneux M. Early versus late paravertebral block for analgesia in video‐assisted thoracoscopic lung resection. A double‐blind, randomized, placebo‐controlled trial. Journal of Cardiothoracic and Vascular Anesthesia 2019; 33: 453–9.
    1. Kaya FN, Turker G, Mogol EB, Bayraktar S. Thoracic paravertebral block for video‐assisted thoracoscopic surgery: single injection versus multiple injections. Journal of Cardiothoracic and Vascular Anesthesia 2012; 26: 90–4.
    1. Bauer C, Pavlakovic I, Mercier C, et al. Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video‐assisted thoracic surgery: a randomised controlled trial. European Journal of Anaesthesiology 2018; 35: 766–73.
    1. Taketa Y, Irisawa Y, Fujitani T. Comparison of analgesic efficacy between two approaches of paravertebral block for thoracotomy: a randomised trial. Acta Anaesthesiologica Scandinavica 2018; 62: 1274–9.
    1. Ciftci B, Ekinci M, Celik EC, Tukac IC, Bayrak Y, Atalay YO. Efficacy of an ultrasound‐guided erector spinae plane block for postoperative analgesia management after video‐assisted thoracic surgery: a prospective randomized study. Journal of Cardiothoracic and Vascular Anesthesia 2020; 34: 444–9.
    1. Liu L, Ni X‐X, Zhang L‐W, Zhao K, Xie H, Zhu J. Effects of ultrasound‐guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial. Journal of Anesthesia 2021; 35: 3–9.
    1. Yao Y, Fu S, Dai S, et al. Impact of ultrasound‐guided erector spinae plane block on postoperative quality of recovery in video‐assisted thoracic surgery: a prospective, randomized, controlled trial. Journal of Clinical Anesthesia 2020; 63: 109783.
    1. Shim J‐G, Ryu K‐H, Kim PO, et al. Evaluation of ultrasound‐guided erector spinae plane block for postoperative management of video‐assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial. Journal of Thoracic Disease 2020; 12: 4174–82.
    1. Zhao H, Xin L, Feng Y. The effect of preoperative erector spinae plane vs. paravertebral blocks on patient‐controlled oxycodone consumption after video‐assisted thoracic surgery: a prospective randomized, blinded, non‐inferiority study. Journal of Clinical Anesthesia 2020; 62: 109737.
    1. Taketa Y, Irisawa Y, Fujitani T. Comparison of ultrasound‐guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video‐assisted thoracic surgery: a randomized controlled non‐inferiority clinical trial. Regional Anesthesia and Pain Medicine 2020; 45: 10–5.
    1. Chen N, Qiao Q, Chen R, Xu Q, Zhang Y, Tian Y. The effect of ultrasound‐guided intercostal nerve block, single‐injection erector spinae plane block and multiple‐injection paravertebral block on postoperative analgesia in thoracoscopic surgery: a randomized, double‐blinded, clinical trial. Journal of Clinical Anesthesia 2020; 59: 106–11.
    1. Turhan Ö, Sivrikoz N, Sungur Z, Duman S, Özkan B, Şentürk M. Thoracic paravertebral block achieves better pain control than erector Spinae Plane Block and Intercostal Nerve Block in thoracoscopic surgery: a randomized study. Journal of Cardiothoracic and Vascular Anesthesia 2020; 35: 2920–7.
    1. Gao Z, Xiao Y, Wang Q, Li Y. Comparison of dexmedetomidine and dexamethasone as adjuvant for ropivacaine in ultrasound‐guided erector spinae plane block for video‐assisted thoracoscopic lobectomy surgery: a randomized, double‐blind, placebo‐controlled trial. Annals of Translational Medicine 2019; 7: 668.
    1. Ökmen K, Metin ÖB. Evaluation of the effect of serratus anterior plane block for pain treatment after video‐assisted thoracoscopic surgery. Anaesthesia, Critical Care and Pain Medicine 2018; 37: 349–53.
    1. Park MH, Kim JA, Ahn HJ, Yang MK, Son HJ, Seong BG. A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery. Anaesthesia 2018; 73: 1260–4.
    1. Viti A, Bertoglio P, Zamperini M, et al. Serratus plane block for video‐assisted thoracoscopic surgery major lung resection: a randomized controlled trial. Interactive Cardiovascular and Thoracic Surgery 2020; 30: 366–72.
    1. Semyonov M, Fedorina E, Grinshpun J, et al. Ultrasound‐guided serratus anterior plane block for analgesia after thoracic surgery. Journal of Pain Research 2019; 12: 953–60.
    1. Kim D‐H, Oh YJ, Lee JG, Ha D, Chang YJ, Kwak HJ. Efficacy of ultrasound‐guided serratus plane block on postoperative quality of recovery and analgesia after video‐assisted thoracic surgery: a randomized, triple‐blind, placebo‐controlled study. Anesthesia and Analgesia 2018; 126: 1353–61.
    1. Chen G, Li Y, Zhang Y, Fang X. Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial. Journal of Pain Research 2019; 12: 2411–7.
    1. Shang LH, Xiao ZN, Zhao YL, Long B. Analgesic effect of serratus anterior plane block after thoracoscopic surgery: a randomized controlled double‐blinded study. Therapeutics and Clinical Risk Management 2020; 16: 1257–65.
    1. Kim S, Bae C‐M, Do YW, Moon S, Baek SI, Lee DH. Serratus anterior plane block and intercostal nerve block after thoracoscopic surgery. Thoracic and Cardiovascular Surgeon 2020; 69: 564–9.
    1. Lee J, Lee DH, Kim S. Serratus anterior plane block versus intercostal nerve block for postoperative analgesic effect after video‐assisted thoracoscopic lobectomy: a randomized prospective study. Medicine 2020; 99: e22102.
    1. Li X, Liu Y, Zhao J, Xiang Z, Ren C, Qiao K. The safety and efficacy of ultrasound‐guided serratus anterior plane block (SAPB) combined with dexmedetomidine for patients undergoing video‐assisted thoracic surgery (VATS): a randomized controlled trial. Journal of Pain Research 2020; 13: 1785–95.
    1. Ekinci M, Ciftci B, Gölboyu BE, Demiraran Y, Bayrak Y, Tulgar S. A randomized trial to compare serratus anterior plane block and erector spinae plane block for pain management following thoracoscopic surgery. Pain Medicine 2020; 21: 1248–54.
    1. Gaballah KM, Soltan WA, Bahgat NM. Ultrasound‐guided serratus plane block versus erector spinae block for postoperative analgesia after video‐assisted thoracoscopy: a pilot randomized controlled trial. Journal of Cardiothoracic and Vascular Anesthesia 2019; 33: 1946–53.
    1. Finnerty DT, McMahon A, McNamara JR, Hartigan SD, Griffin M, Buggy DJ. Comparing erector spinae plane block with serratus anterior plane block for minimally invasive thoracic surgery: a randomised clinical trial. British Journal of Anaesthesia 2020; 125: 802–10.
    1. Zhang X, Zhang C, Zhou X, et al. Analgesic effectiveness of perioperative ultrasound‐guided serratus anterior plane block combined with general anesthesia in patients undergoing video‐assisted thoracoscopic surgery: a systematic review and meta‐analysis. Pain Medicine 2020; 21: 2412–2.
    1. Zejun N, Wei F, Lin L, He D, Haichen C. Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: a prospective, randomized single center study. Thoracic Cancer 2018; 9: 1174–9.
    1. Tseng W‐C, Lin W‐L, Lai H‐C, Huang T‐W, Chen P‐H, Wu Z‐F. Fentanyl‐based intravenous patient‐controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post‐thoracotomy pain following video‐assisted thoracic surgery: a randomized controlled study. Medicine 2019; 98: e16403.
    1. Okajima H, Tanaka O, Ushio M, et al. Ultrasound‐guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery. Journal of Anesthesia 2015; 29: 373–8.
    1. Yeap YL, Wolfe JW, Backfish‐White KM, et al. Randomized prospective study evaluating single‐injection paravertebral block, paravertebral catheter, and thoracic epidural catheter for postoperative regional analgesia after video‐assisted thoracoscopic surgery. Journal of Cardiothoracic and Vascular Anesthesia 2020; 34: 1870–6.
    1. Huang Q‐W, Li J‐B, Huang Y, Zhang W‐Q, Lu Z‐W. A comparison of analgesia after a thoracoscopic lung cancer operation with a sustained epidural block and a sustained paravertebral block: a randomized controlled study. Advances in Therapy 2020; 37: 4000–14.
    1. Harky A, Clarke CG, Kar A, Bashir M. Epidural analgesia versus paravertebral block in video‐assisted thoracoscopic surgery. Interactive Cardiovascular and Thoracic Surgery 2019; 28: 404–6.
    1. Kashiwagi Y, Iida T, Kunisawa T, Iwasaki H. Efficacy of ultrasound‐guided thoracic paravertebral block compared with the epidural analgesia in patients undergoing video‐assisted thoracoscopic surgery. Japanese Journal of Anesthesiology 2015; 64: 1010–4.
    1. Kosinski S, Fryzlewicz E, Wilkojc M, Cmiel A, Zielinski M. Comparison of continuous epidural block and continuous paravertebral block in postoperative analgesia after video‐assisted thoracoscopic surgery lobectomy: a randomised, non‐inferiority trial. Anaesthesiology Intensive Therapy 2016; 48: 280–7.
    1. Hotta K, Endo T, Taira K, et al. Comparison of the analgesic effects of continuous extrapleural block and continuous epidural block after video‐assisted thoracoscopic surgery. Journal of Cardiothoracic and Vascular Anesthesia 2011; 25: 1009–13.
    1. Lee J‐H, Yang W‐D, Han S‐Y, et al. Effect of epidural magnesium on the incidence of chronic postoperative pain after video‐assisted thoracic surgery. Journal of Cardiothoracic and Vascular Anesthesia 2012; 26: 1055–9.
    1. Ahmed Z, Samad K, Ullah H. Role of intercostal nerve block in reducing postoperative pain following video‐assisted thoracoscopy: a randomized controlled trial. Saudi Journal of Anaesthesia 2017; 11: 54–7.
    1. Maher DP, Serna‐Gallegos D, Mardirosian R, et al. The combination of IV and perineural dexamethasone prolongs the analgesic duration of intercostal nerve blocks compared with iv dexamethasone alone. Pain Medicine 2017; 18: 1152–60.
    1. Ghee CD, Fortes DL, Liu C, Khandhar SJ. A randomized controlled trial of continuous subpleural bupivacaine after thoracoscopic surgery. Seminars in Thoracic and Cardiovascular Surgery 2018; 30: 240–9.
    1. Yang HC, Lee J‐Y, Ahn S, et al. Pain control of thoracoscopic major pulmonary resection: is pre‐emptive local bupivacaine injection able to replace the intravenous patient controlled analgesia? Journal of Thoracic Disease 2015; 7: 1960–9.
    1. Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesthesia and Analgesia 2010; 110: 1170–9.
    1. Martinez V, Beloeil H, Marret E, Fletcher D, Ravaud P, Trinquart L. Non‐opioid analgesics in adults after major surgery: systematic review with network meta‐analysis of randomized trials. British Journal of Anaesthesia 2017; 118: 22–31.
    1. Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. New England Journal of Medicine 2004; 350: 2441–51.
    1. Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ. A prospective study of chronic pain after thoracic surgery. Anesthesiology 2017; 126: 938–51.

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