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International Society For Minimally Invasive Cardiothoracic Surgery

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Pain Management After Vats Pulmonary Resections - Which Is Better? Subpleural Continuous Infusion Or Intravenous Patient-controlled Analgesia
Jae Ho Chung1, Sung Ho Lee1, Eunjue Yi1, Hansung Kim2.
1Korea University Medical Center Anam Hospital, Seoul, Korea, Republic of, 2University Yonsei, Department of Biomedical engineering, Seoul, Korea, Republic of.

Objective : Intraveous patient-controlled analgesia (IV PCA) has been used for postoperative pain in video-assisted thoracic surgery (VATS). However, its analgesic efficacy on postoperative pain is still in debate. Recently, subpleural continuous infusion analgesia (ON-Q painbuster) is widely being used. We compared the analgesic effects and side effects of these methods in VATS surgery. Methods : 62 patients treated with VATS pulmonary wedge resection between March and August 2016 were included. The pain severity was measured using Visual Analog pain scale (VAS), additional use of intravenous, intramuscular analgesic drug injections, oral analgesic drugs. Side effects were also reviewed. Results : Group 1 included 32 patients (51.6%) treated with subpleural continuous infusion analgesia and group 2 included 30 patients (48.4%) treated with intravenous patient-controlled analgesia. There was no difference regarding the patient characteristics. However, the postoperative chest tube indwelling time was longer in group 1 (3.53 days vs. 2.1 days, p=0.024). Pain scores measured on postoperative day 0, 1, and 2 did not show any difference between the two groups, however it was lower in group 1 after chest tube removal (1.75 vs 2.67, p<0.001). There was no difference in total number of patients who requested the use of intravenous/intramuscular analgesic injection, however group 1 showed a higher total number of intravenous/intramuscular analgesic injections (1.72 vs. 1, p=0.058). Regarding the side effects, patients with nausea were higher in group 2 (6/30(20%) vs. 1/32(3.1%), p=0.05). Pain relating factors among the subpleural continuous infusion analgesia patients were age, number of thoracoscopic ports, and chest tube size.
Conclusions : Two methods did not show a significant difference in postoperative pain management of simple VATS patients. However, subpleural continuous infusion analgesia showed lower side effects such as nausea. Further study regarding the number of thoracoscopic ports, chest tube size may be needed for the evaluation of postoperative pain management.


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