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Eur J Cardiothorac Surg. 2014 Nov;46(5):907-12. doi: 10.1093/ejcts/ezu092. Epub 2014 Mar 18.

Postoperative pain control: videothoracoscopic versus conservative mini-thoracotomic approach.

Author information

1
Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy claudioandreetti@libero.it.
2
Division of Thoracic Surgery, 'G. Mazzini' Hospital of Teramo, University of L'Aquila, Teramo, Italy.
3
Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy.
4
Division of Thoracic Surgery, Policlinico Umberto I Hospital, Faculty of Pharmacy and Medicine, University of Rome 'Sapienza', Rome, Italy Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy.
5
Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy.

Abstract

OBJECTIVES:

The management of postoperative pain in thoracic surgery is an open issue. The aim of this study was to compare postoperative pain after a videothoracoscopic lobectomy versus a mini-thoracotomy approach.

METHODS:

Between April 2011 and January 2013 we enrolled in a prospective, non-randomized study 145 patients undergoing pulmonary lobectomy with lymphadenectomy for Stage I lung cancer. In 75 cases (Group A), surgery was performed through a videothoracoscopic approach. In 70 cases (Group B), surgery was undertaken through a conservative mini-thoracotomy. Pain was assessed by visual analogue scale and lung function by spirometry and six-minute walking test (6MWT) before surgery, at 48 h and 1 month after surgery.

RESULTS:

Patients were stratified by age, sex, lung function, type and duration of surgery. Length of hospital stay (median, days) was 4 for Group A and 6 for Group B (P = 0.088). The differences between mean postoperative pain values were significant at 1, 12, 24 and 48 h (6.24 vs 8.74, 5.16 vs 7.66, 4.19 vs 6.89 and 2.23 vs 5.33; P = 0.000). In Group A, mean preoperative forced expiratory volume in 1 second values were 2.65 ± 0.61, and 1.83 ± 0.65 and 2.09 ± 0.65, respectively, at 48 h and 1 month (P = 0.028); in Group B, they were 2.71 ± 0.71 preoperatively and 1.33 ± 0.52 and 1.82 ± 0.63, respectively, at 48 h and 1 month. In Group A, mean preoperative 6MWT values (m) were 426.85 ± 51.18, and 371.23 ± 55.36 and 392.07 ± 56.12, respectively, at 48 h and 1 month; in Group B, they were 421.76 ± 56.65 preoperatively and 312.03 ± 48.54 and 331.83 ± 47.99, respectively, at 48 h and 1 month (P = 0.000).

CONCLUSIONS:

The videothoracoscopic approach in the treatment of Stage I lung cancer reduces postoperative pain, which seems to allow a rapid functional recovery of patients.

KEYWORDS:

Pain; Thoracotomy; Video-assisted thoracic surgery lobectomy

PMID:
24648424
DOI:
10.1093/ejcts/ezu092
[Indexed for MEDLINE]

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