Less pain, faster recovery: evaluating 8Fr vs. 22Fr chest tubes in thoracoscopic lung cancer resection.

Background: Chest tube drainage is essential following decortication for stage III empyema thoracis. While double chest tube placement is widely used, a single chest tube may offer comparable efficacy with reduced postoperative pain. This study evaluates the effectiveness of these two approaches. Methods: A retrospective comparative study was conducted on 84 patients at Patna Medical College and Hospital from November 2021 to November 2024. Patients were randomly assigned to either single (Group A) or double (Group B) chest tube drainage. Primary outcomes included total drainage volume, duration of drainage, and pain scores, while secondary outcomes were air leaks, chest tube reinsertion, and hospital stay. Data were analyzed using SPSS, with statistical significance set at p<0.05. Results: Group A had a higher total drainage volume (1200 mL vs. 500 mL) and lower pain scores (2 vs. 3) than Group B. Drainage duration was longer in Group B (5 vs. 4 days), but both groups had similar hospital stays (6-7 days). No reinsertion of chest tubes was required in either group, and lung expansion outcomes were comparable. Conclusion: Single chest tube drainage is slight more effective than double chest tube drainage after decortication, with comparable outcomes and reduced invasiveness, suggesting its utility in clinical practice.

SP35 Transitional pain and prevention of pain chronification

Background chest tube is the most commonly performed surgical procedure in thoracic surgery practice. It is defined as insertion of (chest tube) into the pleural cavity to drain air, blood, bile, pus, chyle or other fluids. Aim of the Work comparison of single and double chest tube drainage management in patients undergoing thoracotomy in the form of pain score, hospital stay, total drainage, residual collection after removal of chest tube and need for another chest tube at Cardiothoracic Academy Hospital and Ain Shams University Specialized Hospital (ASUSH). Patients and Methods this study was conducted on patients who undergone thoracotomy at the Cardiothoracic Academy Hospital and Ain Shams University Specialized Hospital throughout the last 6 months from March 2018 till August 2018. Data was collected retrospectively from 40 patients, 20 patients in each group. In the 20 patients in the ‘single-tube group', only one chest tube was inserted, and in the 20 patients in the ‘double-tube group', two chest tubes were inserted. Pre-, intra- and postoperative variables in both groups were compared. Results 40 patients met all inclusion criteria. The pre- and intraoperative characteristics of the patients were similar in both groups with no significant differences. The single-tube group was found to have a lesser amount of total pleural drainage than the double-tube group but there was no significant difference 202.50 cc vs 297.50 cc, respectively; (p &amp;gt; 0.05). Conclusion our results showed that the single chest tube drainage is more effective, reduces postoperative pain, hospitalization times and duration of drainage in patients who undergo thoracotomy.

BackgroundOur previous retrospective study proved the safety and effectiveness of chest tube clamping in terms of shortening chest tube duration. However, it needed to be verified by a prospective study. This study sought to determine if intermittent chest tube clamping decreases chest tube duration and total drainage volume after lung cancer surgery in patients without air leak.MethodsPatients with resectable lung cancer scheduled to undergo lobectomy were identified as potential candidates. Once the re-expansion of the lung was confirmed via radiography the morning of postoperative day 1 and no air leak was detected, 180 patients were randomly assigned to intermittent chest tube clamping (the clamping group, n=90) or continuous gravity drainage (the control group, n=90). The primary outcome was chest tube drainage duration. Pleural drainage volume and adverse events were also recorded.ResultsOf 180 patients, 12 were subsequently withdrawn from the study for various reasons. In the intention-to-treat analysis, the chest tube drainage duration was significantly shorter {median [interquartile range]: 2 [2, 3] vs. 3 [2, 3] days; P=0.009}, and total drainage volume was much less (mean ± standard deviation: 516.73±410.9 vs. 657.8±448.2 mL; P=0.029) in the clamping group than the control group. In the per-protocol analysis, the chest tube drainage duration was significantly shorter {median [interquartile range]: 2 [2, 3] vs. 3 [2, 3] days; P=0.007}, and total drainage volume was much less (mean ± standard deviation: 437.8±213.9 vs. 604.8±352.8 mL; P=0.001) in the clamping group than the control group. Further, the clamping group showed a major improvement in plasma albumin declination at discharge (mean ± standard deviation: 7.7±2.9 vs. 9.0±5.2 g/L; P=0.040). No severe adverse events were observed in either 2 groups.ConclusionsOur study indicates that chest tube clamping decreased the duration of chest tube drainage and drainage volume without causing adverse effects. Its wider application may help reduce medical costs and increase patient comfort.Trial RegistrationClinicalTrials.gov NCT03379350.

Uniportal video-assisted thoracoscopic surgery (U-VATS) is a well-established minimally invasive approach for lung tumors, but consensus on the optimal size and number of postoperative chest tubes remains lacking. Ultrafine pigtail chest tubes may reduce tissue injury and improve wound healing compared with traditional drainage methods, yet evidence supporting their safety and feasibility in U-VATS patients is insufficient. This retrospective multicenter cohort study enrolled 1,076 lung tumor patients who underwent U-VATS across three Chinese hospitals. Patients were assigned to three groups: double 8F ultrafine chest tube (n = 427), 22F + 8F chest tube (n = 452), and single 24F chest tube (n = 197). Perioperative outcomes were analyzed using 1:1:1 propensity score matching (PSM) and linear regression models to adjust for confounders. Multivariate analysis identified chest tube characteristics, pleural adhesions, postoperative infection, air leakage, intrathoracic hemorrhage, drainage volume as independent factors associated with drainage duration. After PSM (93 cases/group), the double 8F group had significantly lower NRS pain scores [postoperative days (POD) 1-3], reduced early drainage volume (POD1 and POD3), and lower incidences of atelectasis and intrathoracic hemorrhage (all p < 0.05) compared with the 22F + 8F group. It showed comparable hospital stay and total drainage volume to the other two groups. The single 24F group had the shortest drainage duration (p < 0.001), with no intergroup differences in infection, air leakage, reintubation, or chylothorax. Double 8F ultrafine chest tubes do not shorten drainage duration but effectively alleviate postoperative pain (especially on POD1), reduce early postoperative drainage volume, and lower specific complications. Aligning with enhanced recovery after surgery (ERAS) principles, they represent a promising drainage strategy for lung tumor patients after U-VATS.

PurposeThis study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single‐port thoracoscopic pulmonary wedge resection.MethodsFrom January 2019 to July 2021, we collected clinical data on 405 patients who underwent single‐port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups.ResultsFollowing 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade‐1 complication, but no statistical difference in CTCAE grade‐2 complication.ConclusionsA modified drainage strategy in single‐port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload.

This study aimed to compare a modified chest tube drainage strategy with the traditional method in uniportal thoracoscopic pulmonary resection (U-VATS). We retrospectively analyzed 206 U-VATS patients treated at The Second Affiliated Hospital of Wannan Medical College (January 2022–December 2023). Patients were divided into a modified group (n = 46) and a traditional group (n = 160) based on drainage strategy. Propensity score matching (1:1) yielded 80 patients for comparison. Baseline characteristics (age, gender, smoking, BMI, lung function, resection extent, etc) showed no significant differences (P > .05). The modified group demonstrated superior outcomes: lower postoperative pain scores and Chronic postsurgical pain (P < .05), shorter extubation operation time, fewer extubation-related complications, reduced rescue analgesia needs, and better wound healing at the drainage site (P < .05). No differences were observed in operative time, drainage duration, volume, or hospital stay (P > .05). The modified drainage strategy is safe and equally effective for fluid management but reduces postoperative pain, accelerates extubation operation, and minimizes complications versus traditional methods. It may optimize recovery in U-VATS patients.

Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from UVATS, is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach. The clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected, and analyzed. According to whether applied Lu's approach during the VATS operation, patients were divided into the LVATS group and the UVATS group. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. Perioperative variables, including the operation time, intraoperative blood loss, lymph node stations dissected, total drainage volume, drainage duration, postoperative hospital stay, pain score (VAS, Visual Analogue Scale) on the postoperative first day (POD1) and third day (POD3), and incidence of postoperative complications, were compared between the two groups. The data were analyzed statistically with P<0.05 defined as statistically significant. A total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144)min, P <0.001), less intraoperative blood loss(20 (20, 30) VS 25 (20, 50)ml, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50)cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600)ml, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected(5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4)days, P = 0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6)days, P = 0.608), VAS on the POD1(4 (4, 4) VS 4 (4, 4), P = 0.058)and POD3 (3 (3, 4) VS 4 (3, 4), P = 0.219), and incidence of postoperative complications (P = 0.521) between the two groups. Lu's approach is a safe and feasible approach for video-assisted thoracoscopic surgery for the lobectomy of NSCLC. This approach can shorten surgical time, reduce incision length and intraoperative blood loss.

Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: A propensity score–matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma

BackgroundIn this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy.MethodsAccording to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software.ResultsFive studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] −0.60; 95 % confidence intervals [CIs] −0.68–− 0.52; P < 0.00001], duration of drainage [WMD −0.70; 95 % CIs −0.90–− 0.49; P < 0.00001] and hospital stay [WMD −0.51; 95 % CIs −0.91–− 0.12; P = 0.01] compared to patients using a double tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57–1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42–1.58; P = 0.54].ConclusionOur results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.

BackgroundCurrently, thoracoscopic lobectomy is widely used in clinical practice, and postoperative placement of ultrafine drainage tube has advantages of reducing postoperative pain and accelerating postoperative recovery in patients. This study aimed to investigate the feasibility and safety of placement of 8F ultrafine chest drainage tube after thoracoscopic lobectomy and its superiority over traditional 24F chest drainage tube.MethodsA retrospective data analysis was conducted in 169 patients who underwent placement of 8F ultrafine chest drainage tube or 24F chest drainage tube with thoracoscopic lobectomy for lung cancer from January 2018 to December 2019. Propensity score matching (PSM) was used to reduce bias between the experimental group and the control group. After PSM, 134 patients (67 per group) were enrolled. The drainage time, the total drainage volume, postoperative hospital stay, postoperative pain score and postoperative complication of both groups were analyzed and compared.ResultsCompared to group B, group A had lower pain scores on postoperative days 1, 2 and 3 (3.72 ± 0.65point vs 3.94 ± 0.67point, P = 0.027; 2.72 ± 0.93point vs 3.13 ± 1.04point, P = 0.016; and 1.87 ± 0.65point vs 2.39 ± 1.22point, P = 0.005), shorter drainage time (4.25 ± 1.79d vs 6.04 ± 1.96d, P = 0.000), fewer drainage volume (1100.42 ± 701.57 ml vs 1369.39 ± 624.25 ml, P = 0.021); and shorter postoperative hospital stay (8.46 ± 2.48d vs 9.37 ± 1.70d, P = 0.014). Postoperative complications such as subcutaneous emphysema, pulmonary infection, atelectasis, chest tube reinsertion and intrathoracic hemorrhage showed no differences between both groups (P > 0.05).ConclusionCompared with 24F chest drainage tube, the application of an 8F ultrafine chest drainage tube after thoracoscopic lobectomy has significantly shortened the drainage time, reduced the total drainage volume, reduced the postoperative pain degree, shortened the hospital day, and effectively detected postoperative intrathoracic hemorrhage. So, it is considered as an effective, safe and reliable drainage method.

Potential role for immune cell signatures as predictors of acute and chronic pain in adolescents post major musculoskeletal surgery.

Chronic post-surgical pain (CPSP) is a prevalent complication following video-assisted thoracic surgery (VATS), significantly affecting long-term patient outcomes. This study aimed to evaluate the influence of uniport versus multiport VATS on the incidence of CPSP and postoperative recovery at six months. Patients were stratified into uniport and multiport VATS groups, with propensity score matching (PSM). The primary endpoint was the incidence of CPSP at six months. The secondary endpoints comprise the short-term recovery outcomes within 30days postoperatively, the quality of life at six months and group-based trajectory modeling to characterize pain trajectories over six months. After PSM, 222 patients (111 per group) were included in the final analysis. A significant difference in postoperative pain intensity {3(1.8-4) vs 4(3-5), P = 0.007} was observed on postoperative day 3 (POD3). However, no significant difference in CPSP incidence at six months was detected between the uniport and multiport VATS groups. Multivariate logistic regression analysis of the entire cohort identified a high pain score on POD3 as an independent risk factor for CPSP development. Pain trajectory analysis revealed three distinct postoperative pain patterns over the six-month period. Patients in the high pain trajectory required more remedial analgesia and were more likely to develop CPSP. Uniport VATS was not associated with a lower incidence of CPSP compared to multiport VATS at six months postoperatively. A high pain score on POD3 emerged as a significant predictor of CPSP.

Intraoperative dexamethasone and chronic postsurgical pain: a propensity score-matched analysis of a large trial

Although chronic postsurgical pain (CPSP) is a major health care problem, pain-related functional interference has rarely been investigated. Using the PAIN OUT registry, we evaluated patients' pain-related outcomes on the first postoperative day, and their pain-related interference with daily living (Brief Pain Inventory) and neuropathic symptoms (DN4: douleur neuropathique en 4 questions) at 6 months after surgery. Endpoints were pain interference total scores (PITS) and their association with pain and DN4 scores. Furthermore, possible risk factors associated with impaired function at M6 were analyzed by ordinal regression analysis with PITS groups (no to mild, moderate, and severe interference) as a dependent three-stage factor. Odds ratios with 95% confidence intervals were calculated. Of 2322 patients, 15.3% reported CPSP with an average pain score ≥3 (numeric rating scale 0-10). Risk for a higher PITS group increased by 190% (odds ratio [95% confidence interval]: 2.9 [2.7-3.2]; P < 0.001) in patients with CPSP, compared to without CPSP. A positive DN4 independently increased risk by 29% (1.3 [1.12-1.45]; P < 0.001). Preexisting chronic pain (3.6 [2.6-5.1]; P < 0.001), time spent in severe acute pain (2.9 [1.3-6.4]; P = 0.008), neurosurgical back surgery in males (3.6 [1.7-7.6]; P < 0.001), and orthopedic surgery in females (1.7 [1.0-3.0]; P = 0.036) were the variables with strongest association with PITS. Pain interference total scores might provide more precise information about patients' outcomes than pain scores only. Because neuropathic symptoms increase PITS, a suitable instrument for their routine assessment should be defined.