Objective: To explore the application effect of the PDCA cycle combined with predictive nursing in pain management after video-assisted thoracoscopic lobectomy. Methods: A total of 156 patients who underwent video-assisted thoracoscopic lobectomy in our hospital from January 2024 to December 2025 were selected and divided into a control group and an intervention group according to the nursing protocol, with 78 cases in each group. The Visual Analog Scale (VAS) scores at 6 h, 24 h, and 48 h after surgery, the number of effective presses on the analgesic pump, the rate of rescue analgesia, and the incidence of adverse reactions were compared between the two groups. Results: The VAS scores at each time point after surgery in the intervention group were lower than those in the control group (p < 0.05). The number of effective presses on the analgesic pump and the rate of rescue analgesia were significantly reduced in the intervention group (p < 0.05), and the incidence of adverse reactions such as nausea and vomiting was lower than that in the control group (p < 0.05). Conclusion: The PDCA cycle combined with predictive nursing can effectively relieve pain after video-assisted thoracoscopic lobectomy, improve the quality of analgesia, and reduce adverse reactions, which is worthy of clinical promotion and application.