Ask an answerable question (PICO)：
In clinical practice, postoperative acute pain is commonly observed after thoracoscopic surgery. Patients often experience moderate postoperative pain, which can increase morbidity and adversely impact patient recovery. There are varying opinions among healthcare professionals regarding whether blocking pain at its fundamental source can reduce postoperative pain in patients. Some studies suggest that administering Marcaine during surgery can lower postoperative pain in patients undergoing thoracoscopic surgery. Therefore, this paper follows the steps of evidence-based practice to explore this issue, aiming to provide a basis for clinical care.
The Method and Analysis of Literature Review：
Following the Evidence-Based Practice (EBP) steps of asking, acquiring, and appraising, the clinical question was formed: “Does intraoperative intercostal Marcaine injection reduce the pain scale in patients undergoing thoracoscopic surgery?” Utilizing Medical Subject Headings (MeSH) terms, establishing PICO and keywords in both Chinese and English, and applying search strategies by Boolean logic (i.e., AND, OR, NOT), literature searches were conducted in five databases with both Chinese and English resources: Airiti Library, PubMed, Embase, Cochrane Library, and Ovid MEDLINE. The literature type was restricted to systematic reviews (SR) and randomized controlled trials (RCTs). A total of 25 and 348 articles were searched, respectively. After excluding duplicate articles and irrelevant studies not meeting the criteria of the present study, one RCT was included for critical appraisal.
Critical Appraisal：
The 2020 Critical Appraisal Skills Programme (CASP) checklist for randomized controlled trials was employed for critical appraisal. The quality of the selected study meets all 11 criteria, aiming to explore the differences between intraoperative Marcaine intercostal injection and routine care. The result shows a significantly lower pain scale when using intraoperative intercostal injection, as measured by the Visual Analog Scale (VAS). In addition to pain reduction, there is also a decrease in patients’ demand for morphine. According to the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence, the level of the study is classified as Level 2.
Results, Conclusions and Recommendations：
Based on the results of the RCT literature, intraoperative intercostal injection of Marcaine can indeed reduce the pain scale, lower patients’ demand for morphine, and subjects show no adverse reactions. Considering the absence of severe side effects and contraindications in the drug information provided by the Taiwan Food and Drug Administration (TFDA), it is suggested that patients undergoing thoracoscopic surgery may consider intercostal Marcaine injection during surgery to reduce postoperative pain. However, careful attention should be given to any needle hole bleeding at the injection site, and wound closure should only proceed after hemostasis is complete. It is hoped that there will be more clinical care research on reducing postoperative pain after thoracoscopic surgery. Future research could also explore alternative pain management strategies for patients who are not suitable for intercostal injection, aiming to enhance postoperative recovery and improve overall surgical satisfaction.
