Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

Abstract

Objective: To determine the incidence of residual pneumothorax after video-assisted thoracic sympathectomy, with and without postoperative pleural drainage, and to evaluate the possible influence of this type of pneumothorax on postoperative pain within the first 28 postoperative days. Methods: All patients presenting symptoms consistent with primary palmoplantar hyperhidrosis and treated at the Thoracic Surgery Outpatient Clinic of the State Hospital of Sumaré between July and December of 2006 were included. All were submitted to sympathectomy up to the third ganglion using video-assisted thoracoscopy and were randomized to receive or not receive postoperative pleural drainage for 3 h. Chest X-rays and low-dose computed tomography scans of the chest were performed on the first postoperative day in order to determine the incidence of residual pneumothorax. At different time points up to postoperative day 28, patient pain was assessed using a visual numeric scale and by measuring the quantity of opioid analgesics required. Results: This study comprised 56 patients, 27 submitted to bilateral pleural drainage and 29 not submitted to drainage. There was no statistical difference between the two groups in terms of the incidence of post-sympathectomy residual pneumothorax. Residual pneumothorax diagnosed through any of the methods did not influence pain within the first 28 postoperative days. Conclusion: Performing closed pleural drainage for 3 h immediately after video-assisted thoracic sympathectomy did not affect lung re-expansion or the incidence of residual pneumothorax. When residual pneumothorax was present, it did not affect pain within the first 28 postoperative days.Keywords: Hyperhidrosis; Sympathectomy; Pain, postoperative; Pneumothorax; Drainage; Pleura. ResumoObjetivo: Avaliar se o pneumotórax residual após simpatectomia torácica videotoracoscópica tem incidência diferente quando utilizada a drenagem pleural pós-operatória ou não e se este pneumotórax residual, quando presente, pode influenciar a dor pós-operatória até o 28º dia. Métodos: Foram incluídos todos os pacientes com queixa de hiperidrose palmoplantar primária atendidos no Ambulatório de Cirurgia Torácica do Hospital Estadual Sumaré, de julho a dezembro de 2006. Todos foram submetidos à simpatectomia do terceiro gânglio torácico por videotoracoscopia e aleatorizados para receber ou não drenagem pleural pós-operatória por 3 h. Todos foram avaliados no pós-operatório imediato com radiogramas de tórax e tomografia computadorizada de tórax de baixa emissão de energia para detecção de pneumotórax residual. Foram avaliados quanto à dor pós-operatória em diferentes momentos até o 28º dia de pós-operatório, por meio de escala numérica visual e dosagem requerida de analgésicos opióides. Resultados: Foram incluídos 56 pacientes neste estudo, 27 com drenagem pleural bilateral e 29 sem drenagem pleural. Não houve diferença estatística entre a incidência de pneumotórax residual após simpatectomia com e sem drenagem pleural. O pneumotórax residual, q...

Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy

“…In clinical practice, the numeric pain scale is recognized as a preferred pain measurement tool. [12] A 10-degree picture scale, such as the visual analog scale (VAS), is an easy tool for assessing pain. [13] However, the numeric pain scale does not provide data on the quality of pain.…”

Video-Assisted Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: A Meta-Analysis of Randomized Controlled Trials

“…The results of a study that compared VTS of the T2 and T3 suggest that avoiding the T2 ganglion might decrease the risk of CH [ 8 ]. Both T3 and T4 VTS have been reported in the past several years [ 12 , 20 , 21 , 22 ], resulting in fairly good results and a varying incidence of postoperative CH. At present, there remains a lack of expert consensus for the surgical procedure regarding the extent of denervation.…”

Comparison of intrapleural with paravertebral levobupivacaine analgesia for thoracoscopic sympathectomy: A randomized controlled study

“…Although thoracoscopic sympathectomy is rapid and simple technique with rare complications, it is associated with severe pain in the postoperative period. [ 4 5 ] Such pain make breathing and coughing difficult resulting in increased occurrence of pulmonary complications, need for analgesic, and hospital stay. [ 6 ]…”