Early post-operative pain following VATS lobectomy: influences and impact

Abstract

OBJECTIVE: Video Assisted Thoracic Surgery (VATS) causes less pain than open thoracotomy, but does not eliminate it. Factors contributing to - and the clinical impact from - early post-operative pain after VATS lobectomy have not been studied. METHODS: Patients receiving complete VATS lobectomy and lymph node dissection for lung cancer by a single surgeon were eligible for study. Those 117 consecutive patients who received morphine via a patient-controlled analgesia (PCA) system post-operatively were recruited. Pain scores (0-10 scale) in the evening immediately after surgery and in the morning of the first post-operative day were assessed by an independent anesthetic nurse. RESULTS: On discontinuation of the PCA morphine on the first post-operative day, the mean numbers of attempted and successful demands made per patient were 11.4 and 8.6 respectively. The mean pain scores at rest and on coughing were 3.2 and 4.8 respectively immediately post-operatively, falling to 2.4 and 4.2 respectively on the first post-operative day. The key results are summarized in the Table. Younger patients reported higher average pain scores, and male patients made more demands of PCA morphine on average despite reporting similar pain scores as females. Patients who had pleural adhesions tended to make more PCA morphine demands. Longer operation time, greater blood loss, and greater number of mediastinal lymph node stations dissected appeared to be associated with less pain, but the clinical significance of these associations is unclear. The side of operation, the lobe resected, and the cancer stage did not influence pain scores or PCA morphine demands. Higher pain scores and more PCA morphine demands were associated with increased incidence of minor non-air leak complications post-operatively and possibly with prolonged lengths of stay. CONCLUSIONS: Patients who are male, younger, or have pleural adhesions may have greater early post-operative pain and/or analgesic demands after VATS lobectomy. Increased pain scores and analgesic demands observed within the first 24 hours after VATS lobectomy may be associated with complications and prolonged hospital stays.