<p>Characteristics of Postoperative Pain After VATS and Pain-Related Factors: The Experience in National Cancer Center of China</p>

Abstract

Purpose: No final conclusion has yet been reached on characteristics of postoperative pain and pain-related factors after video-assisted thoracoscopic surgery (VATS). This study was designed to explore features of acute severe pain and chronic post-surgical pain (CPSP), and the pain-related factors of VATS. Patients and Methods: Data of patients who underwent VATS for lung cancer in Cancer Hospital, Chinese Academy of Medical Sciences between March 2017 and January 2019 were reviewed in this retrospective study. A numerical rating scale (NRS) was used for evaluating the intensity of postoperative pain including no pain (NRS=0), mild pain (NRS=1-3), moderate pain (NRS=4-6), and severe pain (NRS=7-10). Pain intensity was assessed daily within a week after operation, and also evaluated at 3 months postoperatively. Results: One hundred and five (3.4%) of the 3072 patients enrolled experienced severe pain (NRS=7-10) on the 1st day after operation, and 17 (0.6%) on the 2nd day. Smoking history, three-port VATS, prolonged operation time, and without patient-controlled analgesia (PCA) were correlated to increased incidence of severe pain. Among all patients, 237 (7.7%) cases generated CPSP, and VATS type, operation time, duration of drainage, and severe pain on the 1st day were four independent risk factors related to CPSP. Conclusion: Patients seemed to experience a lower incidence of acute severe pain and CPSP after VATS than traditional open surgery. Acute severe pain was correlated with smoking history, VATS type, operation time, and PCA; VATS type, operation time, duration of drainage, and severe pain on the 1st day postoperatively were four independent risk factors of CPSP.

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

“…Previously published meta-analysis reported the incidence of CPSP after thoracotomy was 57%, but data about the risk of developing CPSP after VATS were not sufficient to summarize [3,15]. The reported incidences of CPSP after VATS range from 7.7 to 50% [1], apparently, our result ranks at a higher level of it. The relatively higher incidence may be explained by the definition of CPSP we used.…”

“…Chronic postsurgical pain (CPSP) is defined as chronic pain that develops or increases in intensity after a surgical procedure or a tissue injury and persists beyond the healing process, i.e., at least 3 months after the surgery or tissue trauma by International Classification of Diseases-11 (ICD-11) [ 1 ], and its incidence varies from 3 to 85% according to surgery type [ 2 ]. As traumatic as thoracotomy, the reported incidence of CPSP can be up to 57% [ 3 ].…”

“…Since video-assisted thoracoscopic surgery (VATS) was introduced into clinical practice in the early 1990s, it has been widely used as an alternative to thoracotomy over the past 30 years [ 4 ]. Though it was considered less injury than thoracotomy and with relief of postoperative acute pain, the incidence of CPSP after VATS has been reported to range from 7.7 to 50% [ 1 ]. Limited by small sample size and inconsistent follow-up time, the reported incidence of CPSP following VATS varies widely and we can’t reach a comprehensive summary about the occurrence of CPSP after VATS at present.…”

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

“…This leads to a faster recovery, less acute pain postoperatively, and a lower incidence of chronic pain. 11,12 Nonetheless, patients who undergo MICTS still frequently experience severe postoperative pain, [13][14][15][16] and the prevalence of PTPS after video-assisted thoracoscopic surgery (VATS) is still approximately 30%. 17 Multimodal pain management strategies have been championed as part of fast-tracked enhanced recovery after surgery (ERAS) programs to reduce the postoperative morbidity and mortality associated with poorly controlled pain and to address the multifactorial pathophysiology of thoracotomy pain.…”

Ultrasound-guided Serratus Anterior Plane Block Versus Thoracic Paravertebral Block on Alleviating the Acute and Chronic Pain Following the Video-assisted Thoracic Surgery: a Prospective, Randomized, Double-blinded Non-inferiority Clinical Trial

“…Previous studies have suggested that the postoperative acute pain is a predictive factor for the following chronic pain [18][19][20] , indicating that an e cient acute pain management contributes to prevent postoperative chronic pain. Exist evidences have supported the role of PVB to manage the neuralgia, myofascial thoracic pain, and chronic pain following thoractomy [21][22] .…”