213POST-THORACOTOMY PAIN: VIDEOTHORACOSCOPIC VERSUS MINITHORACOTOMY APPROACH

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_2; p. S121
• Main Authors: Menna, C., Andreetti, C., Ibrahim, M., D'Andrilli, A., Ciccone, A.M., Maurizi, G., Poggi, C., Rendina, E.A.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.213

Objectives: The management of postoperative pain in thoracic surgery is an open issue. The aim of this study is to compare postoperative pain after a videothoracoscopic lobectomy versus a minithoracotomy 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 and infiltration with ropivacaine before incision. In 70 cases (group B) surgery was undertaken through a minithoracotomy with intrapleural intercostal nerve block and intercostal muscle flap. Pain was assessed by visual analogue scale (VAS), lung function by spirometry and six-minute walk test before surgery, at 48 h and one month after surgery. Results: Patients were stratified by age, sex, lung function, type and duration of surgery. Mean hospital stay was 4.6 days for group A and 6.7 days for group B (P = 0.01). The differences between mean postoperative pain values were significant at 1 h, 12 h, 24 h and 48 h (P = 0.01). In group A mean preoperative FEV1 values were 2.65 ± 0.61, and 1.83 ± 0.65 and 2.09 ± 0.56 respectively at 48 h and one month; in group B they were 2.70 ± 0.71 preoperatively and 1.33 ± 0.52 and 1.82 ± 0.63 respectively at 48 h and one month. In group A, mean preoperative walking test values (metres) were 426.85 ± 0.51, and 371.23 ± 0.55 and 392.07 ± 0.56 respectively at 48 h and one month; in group B they were 421.75 ± 0.47 preoperatively and 312.03 ± 0.51 and 331.82 ± 0.53 respectively at 48 h and one month. Conclusions: The videothoracoscopic approach in the treatment of stage I lung cancer reduces postoperative pain, allowing patients to rapidly return to normal daily activities.