Randomized controlled trial of an alternative drainage strategy vs routine chest tube insertion for postoperative pain after thoracoscopic wedge resection

Abstract

Background Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. Indwelling drainage tubes are one of the leading causes of postoperative pain after thoracic surgery. Therefore, the aim of this study was to explore the effects of alternative drainage on acute and chronic pain after video-assisted thoracoscopic surgery (VATS). Methods Ninety-two patients undergoing lung wedge resection were selected and randomly assigned to the conventional chest tube (CT) group and the 7-Fr central venous catheter (VC) group. Next, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain. Results NRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 h after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal. Moreover, the number of postoperative salvage analgesics (such as nonsteroidal anti-inflammatory drugs [(NSAIDs]) and postoperative hospitalization days were notably reduced in the VC group compared with the CT group. However, no significant difference was observed in terms of NRS pain scores between the two groups of patients during the follow-up for chronic pain at 3 months and 6 months. Conclusion In conclusion, a drainage strategy using a 7-Fr central VC can effectively relieve perioperative pain in selected patients undergoing VATS wedge resection, and this may promote the rapid recovery of such patients after surgery. Trial registration ClinicalTrials.gov, NCT03230019. Registered July 23, 2017.

Comparison of Central Venous Catheter Thoracic Drainage with Traditional Closed Thoracic Drainage after Minimally Invasive Surgery for Esophageal Cancer: A Retrospective Study

“…Recent studies have shown that central venous catheters can be a safe and effective alternative to traditional chest tubes for thoracic drainage 13 . In addition to reducing postoperative pain and discomfort, central venous catheters have also been shown to simplify patient mobility and decrease the risk of postoperative thrombosis 14 . Furthermore, they have been widely used in the treatment of primary or secondary pleural effusion drainage, traumatic hemothorax, and tuberculous pleurisy, and have been found to be cost-e cient 6,15 .…”

The effects of different analgesic methods on chronic pain in patients undergoing video-assisted thoracoscopic surgery

“…Poor management of early postoperative pain may lead to a high incidence of CPSP, which severely impairs physical function and quality of life [18]. The CPSP incidence after VATS, which is highly variable, is reported as 11-35% by Wei et al [1], 40-60% by Takenaka et al [2], 14-83% by Peng et al [19], 4-47% by Chaudhary et al [20], and 25-75% by Wildgaard et al [5]. In this study, 110 (55.2%) patients suffered from CPSP (NRS scores exceed 0 at 3 months after VATS).…”

“…Postoperative pain is one of the most common complaints from patients after thoracic surgery. It is attributed to many factors, including intercostal nerve injury, pulmonary parenchymal injury, chest tube placement, and systemic inflammatory response [ 1 ]. Poor pain management may lead to chronic post-surgical pain (CPSP), which can severely impair physical function and quality of life.…”

Editorial: Early chest drain removal following lung resection

“…Another method which was widely performed was the temporary insertion of a chest drain inside the pleural cavity (10,11,22,(24)(25)(26)(27)(28)(30)(31)(32)(33). After closing all the intra-operative chest wall incisions, the drain was subsequently either connected to a digital suction system with negative suction (24, 27, 28, 30, 31,35) or its extra-thoracic end was simply immersed to a bowl with sterile water (10,11,22,32) while the anesthetic team administered manually positive inspiratory pressures.…”

“…Then if there was no air leak by both the anesthesiologist assessment of volume delivered and returned and by the digital air leak meter attached to the chest tube the chest drain was removed before extubation. In some studies, the investigators decided to leave either a central line or an ABLE catheter within the chest as a safety net to evacuate excess air of fluid if required (21,22,32,33). The size of the temporary chest drain ranged from 12 Fr to 24 Fr while in two cases the researchers used a nasogastric tube (19) and a Ryles' tube (11) to assess intra-operatively the presence of air leak.…”