Comparison of Postoperative Pain after Different Thoracic Surgery Approaches as Measured by Electrical Stimulation.

BACKGROUND: Postoperative pain is commonly evaluated using the numerous rating scale (NRS), visual analogue scale, or pain scale; however, these assessments are easily affected by various subjective factors. We measured the degree of postoperative chest pain among different thoracic surgery approaches using NRS and electrical stimulation measurements. METHODS: Seventy patients who underwent lobectomy or segmentectomy were enrolled. Concomitant with NRS, pain scores were quantitatively measured on postoperative day 2 using an electrical neurostimulator to compare the degree of pain among three different surgical approaches: pure video-assisted thoracic surgery (VATS), hybrid VATS, and conventional thoracotomy. The risk factors associated with postoperative pain were also analyzed. RESULTS: Thirty patients underwent lung resection with pure VATS, while 30 had hybrid VATS, and 10 had conventional thoracotomy. Among the three surgical approaches, analyzing the pain score indicated statistically significant differences (pure, 159.50 ± 26.22; hybrid, 269.36 ± 30.49; thoracotomy, 589.40 ± 141.11; p = 0.003); however, NRS did not obtain a statistically significant difference between the three approaches (pure, 4.26 ± 0.27; hybrid, 4.96 ± 0.30; thoracotomy, 5.50 ± 0.68; p = 0.105). A multivariate analysis showed that the surgical approach was an independent risk factor for postoperative pain as determined by the pain score (pure vs. hybrid, p = 0.076; pure vs. thoracotomy, p < 0.001). CONCLUSION: For lung surgery, the differences in surgical approach were an independent risk factor for postoperative pain. In the early postoperative period, pure VATS was shown to be the least painful of the three surgical approaches.

[Assessment of Feasibility of Early Ambulation and Food-intake on the Operative Day after Lung Resection].

To decrease the risk of morbidity, we have started an early ambulation and food-intake program conducted on the same day as pulmonary resection. This protocol was developed with consideration of the characteristics of lung surgery and conducted through an interdisciplinary team-approach. The assessment of feasibility and clinical effectiveness of this protocol was evaluated in 64 consecutive patients. No apparent adverse effect relating to this protocol was recorded. Fifty-five of 64 patients( 80%) were able to accomplish ambulation to the up-right standing position. Thirty-four of 64 patients( 53%) were able to consume more than half the amount of their hospital supper. No patients, including 5 patients who had had a past-history of postoperative delirium after their previous surgery, developed postoperative delirium after conducting this protocol. This protocol, which consisted of extraordinary early ambulation and food-intake on the operative day, was done safely and is expected to have some benefit as a postoperative management protocol for lung surgery.