Comparison of postoperative pain and pain control techniques in uniportal and biportal VATS and open surgery patients

Year 2021, , 260 - 266, 27.10.2021

Cagatay Cetınkaya Zeynep Bılgı , Tunc Lacın Korkut Bostancı Bedrettin Yıldızelı Mustafa Yuksel Hasan Fevzi Batırel

https://doi.org/10.5472/marumj.984215

Abstract

Objectives: Thoracotomy causes intense postoperative pain which may become chronic. Video-assisted thoracic surgery (VATS)
leads to less postoperative pain compared with thoracotomy. In this study, we analyzed pain scores in patients who underwent lung
resections with VATS or thoracotomy.
Patients and Methods: Patients who underwent lung resections with uniportal, biportal VATS or thoracotomy between May 2015
– May 2017 were included in the study. Visual Analogue Scale (VAS) pain scores were recorded on postoperative day 1, 5 (or at
discharge), 2nd week, 1st and 3rd months. Patients were classified in 3 groups, uniportal VATS (n=178), biportal VATS (n=15),
thoracotomy (n=60). Demographics, resection type, mortality, morbidity and epidural catheter use were recorded.
Results: Two hundred and fifty-three patients (average age was 57.3 ± 12.7, 94 females) were included in the study. Median hospital
stay was 5 days. Uniportal and biportal groups had significantly lower pain scores in all intervals compared with thoracotomy. No
chronic pain was seen in VATS groups. Uniportal and biportal groups had similar pain scores at all times. Epidural use or size of
specimen did not affect pain in VATS patients (p=0.18 vs p=0.68).
Conclusion: Video-assisted thoracic surgery decreases the need for epidural patient control analgesia. Specimen size does not affect
postoperative pain and chronic pain is rare.

Keywords

Thoracoscopy, uniportal, biportal, postoperative analgesia

References

• Ochroch EA, Gottschalk A, Augostides J et al. Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology. 2002 Nov;97(5):1234-44. doi: 10.1097/00000542-200211000-00029.
• Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004 Aug;14(3):345-52. doi: 10.1016/S1547-4127(04)00022-2
• Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008 Dec;86(6):2008-16; discussion 2016-8. doi: 10.1016/j.athoracsur.2008.07.009
• 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 Oncol. 2016 Jun;17(6):836-844. doi: 10.1016/S1470-2045(16)00173-X
• Varela G, Brunelli A, Rocco G et al. Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. Eur J Cardiothorac Surg. 2006 Oct;30(4):644-8. doi: 10.1016/j.ejcts.2006.07.001
• Rizk NP, Ghanie AM, Meier H et al. A Prospective Trial Comparing Pain and Quality of Life Measures after Anatomic Lung Resection Using Either Thoracoscopy or Thoracotomy. Ann Thorac Surg. 2014 October ; 98(4): 1160–1166. doi: 10.1016/j.athoracsur.2014.05.028
• Nomori H, Cong Y, Sugimura H. Limited thoracotomy for segmentectomy: a comparison of postoperative pain with thoracoscopic lobectomy. Surg Today. 2016 Nov;46(11):1243-8. doi: 10.1007/s00595-015-1302-4
• Landreneau RJ, Mack MJ, Hazelrigg SR et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg 1994;107:1079–86. doi: 10.1097/00132586-199412000-00051
• Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014; 101:172–188. doi: 10.1002/bjs.9394
• Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS1) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2018. doi: 10.1093/ejcts/ezy301
• Batchelor TJP, Ljungqvist O. A surgivcal perspective of ERAS guidelines in thoracic surgery. Curr Opin Anaesthesiol. 2019 Feb;32(1):17-22. doi: 10.1097/ACO.0000000000000685
• Jutley RS, Khalil MW, Rocco G. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of postoperative pain and residual paraesthesia. Eur J Cardiothorac Surg 2005;28: 43–6. doi: 10.1016/j.ejcts.2005.02.039
• McElnay PJ, Molyneux M, Krishnadas R, Batchelor TJP, West D, Casali G. Pain and recovery are comparable after either uniportal or multiport videoassisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg 2015 May;47(5):912-5. doi: 10.1093/ejcts/ezu324
• Kwon ST, Zhao L, Reddy RM et al. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection. J Thorac Cardiovasc Surg. 2017 Aug;154(2):652-659. doi: 10.1016/j.jtcvs.2017.02.008 Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004 Aug;14(3):345-52. doi: 10.1016/S1547-4127(04)00022-2
• Kim JA, Kim TH, Yang M et al. Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy? J Korean Med Sci. 2009 Oct;24(5):930-5. doi: 10.3346/jkms.2009.24.5.930
• Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques.Anesthesiology. 1994 Sep;81(3):737-59. doi: 10.1097/00000542-199409000-00028
• Huang A, Azam A, Segal S et al. Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service. Pain Manag. 2016 Oct;6(5):435-43. doi: 10.2217/pmt-2016-0004
• Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011;185(2):551-555 doi: 10.1016/j.juro.2010.09.088
• Alam A, Gomes T, Zheng H , Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012 Mar 12;172(5):425-30. doi: 10.1001/archinternmed.2011.1827