Which is the Best Minimal Invasive Approach for the Treatment of Spontaneous Pneumothorax? Uniport, Two, or Three Ports: A Prospective Randomized Trail

2018 ◽  
Vol 66 (07) ◽  
pp. 589-594 ◽  
Author(s):  
Celalettin Kocaturk ◽  
Hasan Akin ◽  
Sertan Erdogan ◽  
Salih Bilen ◽  
Kemal Karapinar ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Standard Treatment ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Treatment Method ◽  
Minimal Invasive ◽  
Invasive Approach ◽  
Pain Scores ◽  
Minimal Invasive Approach ◽  
Video Assisted Thoracoscopic Surgery

Objective Video-assisted thoracoscopic surgery (VATS) has become the standard treatment method for primary spontaneous pneumothorax. Concerns about lesser pain and better cosmesis led to the evolution of uniportal access. This study prospectively compared the results of the uniportal, two-port, and three-port thoracoscopic surgery. Material and Methods One hundred and thirty-five patients were randomized into three groups according to the port numbers. The groups were compared regarding the operation time, hospital stay, amount of drainage, area of pleurectomy, complications, recurrences, and pain scores. Results Except for the amount of drainage (p = 0.03), no factors were found to be statistically significant. The overall recurrence rate was 5%. Although the first and second week pain scores were not statistically significant, the single-incision group patients had significantly less pain at 4, 24, and 72 hours (p < 0.05). Conclusion The study indicated that uniportal VATS approach is less painful and has better cosmetic results, besides it is as efficient as two- or three-port VATS approach.

scholarly journals Single-port VATS combined with non-indwelling drain in ERAS: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiantian Yang ◽  
Wencong Huang ◽  
Peijian Li ◽  
Huizhen Hu ◽  
Yongsheng Li ◽  
...  
Keyword(s):  
Single Port ◽  
Enhanced Recovery ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Pain Scores ◽  
Significant Difference ◽  
Lower Pain ◽  
Drain Group ◽  
Hospital Stays ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background We investigated single-port video-assisted thoracoscopic surgery (VATS) combined with a postoperative non-indwelling drain in enhanced recovery after surgery (ERAS). Methods The clinical data of 127 patients who underwent double- and single-port VATS from January 2018 to December 2019 were analyzed retrospectively. The groups constituted 71 cases undergoing double-port and 56 cases undergoing single-port VATS (30 cases in the indwelling drain group and 26 cases in the non-indwelling drain group). The incidence of postoperative complications, pain scores, and postoperative hospital stay were compared between the two groups. Results Compared with the double-port group, the single-port group had shorter postoperative hospital stays and lower pain scores on the first and third postoperative days (P < 0.05). Pain scores on the first and third days were lower in the single-port non-indwelling drain group than in the single-port indwelling drain group (P < 0.05), and the postoperative hospitalization time was significantly shorter in the single-port group (P < 0.05). However, there was no significant difference between the two groups for operation time, incidence of complications, and pain scores 1 month after operation (P > 0.05). Conclusions The combination of single-port VATS with a non-indwelling drain can relieve postoperative pain, help patients recover quickly, and is in accordance with ERAS.

scholarly journals Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jian Wei Tan ◽  
Jameelah Sheik Mohamed ◽  
John Kit Chung Tam
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Urinary Retention ◽  
Feasibility Study ◽  
Thoracoscopic Surgery ◽  
Early Recovery ◽  
Rescue Analgesia ◽  
Video Assisted ◽  
Pain Scores ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

An Audit of Pain Control Pathways following Video-Assisted Thoracoscopic Surgery

2011 ◽  
Vol 6 (4) ◽  
pp. 248-252 ◽  
Author(s):  
Espeed Khoshbin ◽  
Ali N. Al-Jilaihawi ◽  
Nicholas B. Scott ◽  
Dhruva Prakash ◽  
Alan J. B. Kirk
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Severe Pain ◽  
Thoracoscopic Surgery ◽  
Analog Scale ◽  
Pain Scores ◽  
Audit Commission ◽  
Video Assisted Thoracoscopic Surgery ◽  
Daily Pain

Objective To compare different modes of pain management following video-assisted thoracoscopic surgery (VATS) to our national standard. Methods This is an audit based on patient's experiences. One hundred consecutive patients who underwent VATS with or without pleurodesis were managed by one of the following pain relief pathways: (A) thoracic paravertebral block + morphine patient-controlled analgesia (PCA), (B) percutaneous thoracic paravertebral catheter +/– morphine PCA, (C) thoracic epidural +/– morphine PCA, (D) morphine PCA alone, and (E) intravenous or subcutaneous morphine as required. Pain score was documented up to four times per day for each patient. The incidence of severe pain was defined as visual analog scale ≥7. The results were compared with the standard set by the audit commission for postoperative pain relief in the UK. The mean daily pain scores were calculated retrospectively for all patients. Results There were no statistically significant differences in mean daily pain scores irrespective of having a pleurodesis. The percentage of patients experiencing severe pain was 34% [mean visual analog scale = 8 (standard deviation = 1.0)]. This was almost seven times the standard. Among these pathways, B had the least percentage incidence of severe pain (16.7%) followed by A (25.0%) D (33.3%), C (35.7%), and E (52.4%). Conclusions We are not compliant with the standards set by the audit commission. Pain management in theater recovery needs to be targeted. In the light of these results, we recommend the use of percutaneous thoracic paravertebral catheter +/– morphine PCA for postoperative VATS pain relief.

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