Table 1_Efficacy of repetitive transcranial magnetic stimulation on postoperative pain in patients undergoing video-assisted thoracoscopic surgery: study protocol for a prospective, single-center, randomized controlled trial.docx

BackgroundVideo-assisted thoracoscopic surgery (VATS) is a key treatment for many cardiothoracic issues, but intraoperative factors can lead to acute postoperative pain (APSP), impacting recovery and quality of life. While multimodal analgesic methods are used, they have notable side effects. Repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive pain relief option by stimulating the primary motor cortex (M1), effective in chronic pain management. However, its role in preventing and treating APSP after VATS needs confirmation through high-quality clinical trials.
Methods/designIn this single-center, prospective, double-blind, randomized controlled trial, a total of 260 patients slated for VATS will be randomly allocated in a 1:1 ratio to either an active rTMS group or a sham rTMS group. Both groups will receive a 20-min intervention at two specified time points: (1) the afternoon before the surgery while in the ward, and (2) 30 min before the surgical procedure on the day of the operation. The primary outcome measure is the incidence of moderate-to-severe pain at 24 h following surgery. Secondary outcome measures encompass pain scores at rest and during movement at specified time points (T1: 2 h, T2: 6 h, T3: 12 h, T4: 24 h, T5: 48 h, T6: 90 days postoperatively), total consumption of rescue analgesics, quantified in morphine milligram equivalents (MME) within the initial 48 h, time to first request for patient-controlled intravenous analgesia (PCIA), extubation duration, length of stay in the post-anesthesia care unit (PACU), and the Quality of Recovery-15 (QoR-15) score at 24 and 48 h postoperatively. All outcomes will be assessed utilizing validated instruments.
DiscussionAPSP remains a significant clinical issue, affecting patient outcomes and quality of life. rTMS, a promising non-invasive technique, has shown potential in treating mental disorders, neurological conditions, and chronic pain. This study aims to provide strong evidence on the effectiveness of rTMS in reducing acute pain after VATS, potentially enhancing multimodal postoperative pain management strategies.
Clinical trial registration[http://www.chictr.org.cn], identifier [ChiCTR2500111517].