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Thorac Cardiovasc Surg 2015; 63(06): 519-525
DOI: 10.1055/s-0035-1546427
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

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

Norifumi Tsubokawa
1   Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
,
Hiroaki Harada
1   Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
,
Chie Takenaka
1   Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
,
Keizo Misumi
1   Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
,
Yoshinori Yamashita
1   Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
› Author Affiliations
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Publication History

07 August 2014

10 December 2014

Publication Date:
13 March 2015 (online)

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Abstract

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.

Keywords

surgery - complications - video-assisted thoracic surgery - postoperative care