• Bertram Vorm, Anni Nørgaard Jeppesen, Lene Mølgaard Hansen, Mads Lumholdt, Thomas Lass Klitgaard, Allan Vestergaard Danielsen, Peter Juhl-Olsen, Phillip Sperling, and Jannie Bisgaard.
• Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
• Acta Anaesthesiol Scand. 2025 Mar 1; 69 (3): e14577e14577.

BackgroundVideo-assisted thoracoscopic surgery (VATS) is widely used in lung cancer surgery, as this technique causes less pain and faster recovery than open thoracotomy. However, significant postoperative pain persists in a number of patients, often leading to increased opioid use and opioid-related adverse events in addition to prolonged admission times. Perioperatively administered glucocorticoids have been demonstrated effective in reducing pain after other types of surgeries, but the effect in VATS remains unclear.MethodsThis systematic review will assess the impact of glucocorticoids on postoperative pain in adult patients undergoing VATS. We will include randomised trials comparing higher doses of glucocorticoids to lower doses, placebo or no treatment. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and Cochrane methodology. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation system. The primary outcome is standardised dynamic pain scores within 24 h. Secondary outcomes are opioid use, time to first mobilisation, length of hospital stay and numeric rating score >3 at any point within the first 24 h following surgery. Exploratory outcomes are opioid-related adverse effects and glucocorticoid-related adverse effects classified in major and minor events. Data will be meta-analysed with sensitivity and subgroup analyses and trial sequential analyses. Furthermore, we will assess the risk of reporting bias and heterogeneity.ConclusionThis systematic review and meta-analysis will provide an overview of the current evidence of how glucocorticoids affect postoperative pain and recovery in adult patients undergoing VATS.© 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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