Background: Uniportal video-assisted thoracoscopic surgery (VATS) is gaining popularity internationally, but remains an uncommon practice in the United States. One proposed benefit is a decrease in narcotic usage and peri-operative pain when compared to traditional multiple incision VATS. The purpose of this study was to determine the post-operative narcotic usage between patients undergoing anatomic lobectomy via traditional VATS as compared to patients undergoing uniportal VATS.Methods: All consecutive patients undergoing anatomic lobectomy for presumed malignancy by a single surgeon at an academic medical institution were recorded between July 2013 and September 2015. Patients were excluded if they were narcotic dependent prior to the operation, if they had an epidural catheter placed, or if they were under 18 years of age. All narcotics were converted to oral morphine equivalents (OMEq) using standard formulas.Results: Data were collected on 84 patients. There was no difference between groups with regard to age, gender, tumor size, length of stay, or duration of post-operative thoracostomy. The groups had a similar rate of complications including post-operative atrial fibrillation and need for prolonged thoracostomy. Patients undergoing uniportal VATS had significantly lower narcotic usage in the recovery room, and on postoperative days 1 and 2. In addition, the total narcotic usage during their inpatient stay was significantly lower for patients undergoing uniportal VATS.Conclusions: Uniportal VATS is a safe and effective strategy for the surgical management of benign and malignant lung disease. In patients undergoing anatomic lobectomy, there was an association with significantly less post-operative narcotic usage in patients undergoing uniportal VATS when compared to traditional VATS. This emerging technology may benefit patients by allowing less narcotic usage during their post-operative hospitalization. and other major thoracic procedures (3-6). Though the popularity of uniportal VATS continues to grow, it is not without significant detraction and the debate on its efficacy and proper use continues (7). A recent metaanalysis demonstrated favorable outcomes when comparing multiport with uniportal VATS with regard to postoperative hospitalization, thoracostomy drainage duration, and morbidity (8).Uniportal technique offers several potential benefits, one of which is decreased postoperative pain and resultant narcotic usage. In patients undergoing thoracoscopy for pneumothorax, uniportal technique was associated with decreased postoperative pain (9). Though a recent randomized study attempted to address this issue, there was considerable variation in methodology, particularly in the surgical technique used (10). Another observational study failed to show an appreciable difference in pain when comparing uniportal lobectomy to standard VATS technique, though the study was done as a non-inferiority report and included only 15 patients in the uniportal arm (11).In addition, the previous studies have largely us...

Background. Liposomal bupivacaine field block is gaining popularity as a critical element of enhanced recovery after surgery protocols in thoracic surgery. Uniportal thoracoscopic surgery has been reported to result in less narcotic consumption compared with traditional video-assisted thoracoscopic surgery. The objective of this study was to evaluate the postoperative narcotic consumption of patients undergoing uniportal thoracoscopic lobectomy with the use of 0.25% bupivacaine vs patients treated with liposomal bupivacaine.Methods. All consecutive patients undergoing uniportal thoracoscopic lobectomy at an academic medical institution were recorded between October 2015 and February 2018. Narcotic consumption was converted to oral morphine equivalents by using standard formulas. Patients underwent posterior serratus and intercostal nerve blocks with 0.25% bupivacaine or liposomal bupivacaine, transitioning to liposomal bupivacaine in March 2017. Other adjuncts such as gabapentin or cyclooxygenase-2 inhibitors were not administered.Results. Data were reviewed on 32 patients receiving field blocks with 0.25% bupivacaine and on 50 patients receiving liposomal bupivacaine. There was no difference between groups with regard to age, sex, chest tube duration, or length of stay. Patients undergoing field blocks with liposomal bupivacaine consumed less narcotic medication.Conclusions. The study investigators have previously demonstrated decreased narcotic consumption with the use of uniportal technique over traditional multi-incision thoracoscopic surgery. The use of liposomal bupivacaine for posterior serratus and intercostal field blocks enhanced pain control and decreased narcotic consumption.

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