Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax

Abstract

Background: This study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax. Methods: We retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007-2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay. Results: Blebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42-95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001). Conclusions: After video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.

Incidence and risk factors for chronic postsurgical pain following video-assisted thoracoscopic surgery: a retrospective study

“…During the telephone interview, we assessed patients’ CPSP according to a pre-formulated list of questions, which ensured the homogeneity of the follow-up process. Besides, due to the long follow-up time of CPSP, other authors often use telephone follow-up to obtain relevant data [ 8 , 35 ]. Additionally, for the data collected from in a single institution, the results may be influenced by the selection bias.…”

Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis

“…Thereafter, 183 records were carefully reviewed to ensure compliance with the inclusion criteria. Ultimately, 17 studies [10][11][12][20][21][22][23][24][25][26][27][28][29][30][31][32][33], comprising 10,525 patients who underwent VATS, were included in this study (Fig. 1).…”

“…In recent years, several studies have evaluated CPSP after thoracoscopic surgery, although significant controversy still exists surrounding their findings [ 10 , 11 ]. Furthermore, the etiology of CPSP after VATS is multifactorial and may involve both patient- and treatment-related factors [ 12 ]. Although multiple retrospective studies have investigated the predictors of CPSP after VATS, there were significant dissimilarities due to confounding of the predictors assessed in these studies, leading to inconclusive results.…”

“…Although multiple retrospective studies have investigated the predictors of CPSP after VATS, there were significant dissimilarities due to confounding of the predictors assessed in these studies, leading to inconclusive results. More notably, some studies on predictors of CPSP after VATS did not report effect estimates for nonsignificant predictors or predictors that were significant in the univariate analysis although nonsignificant in the multivariate analysis [ 12 ]. This may have led to the exaggeration of existing predictors and neglect of potential predictors.…”

Nomogram prediction of chronic postsurgical pain in patients with lung adenocarcinoma after video-assisted thoracoscopic surgery: A prospective study

“…In recent years, a number of retrospective studies have investigated the associated risk factors for the development of CPSP after VATS, including body mass index (BMI), history of pain, and acute postoperative pain (13,14,(16)(17)(18)(19). Further, studies have indicated that microRNAs (miRNAs) in the peripheral blood of patients with chronic neuropathic pain are closely associated with chronic neuropathic pain (20-22).…”