Randomized controlled trial of an alternative drainage strategy vs routine chest tube insertion for postoperative pain after thoracoscopic wedge resection

Shoucun Wei,Wenzhao Zhong,Jiatao Zhang,Guangyan Zhang,Jianxiu Cui,Lidan Nong,Jue Ma

doi:10.1186/s12871-022-01569-w

Abstract

BackgroundThoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. Indwelling drainage tubes are one of the leading causes of postoperative pain after thoracic surgery. Therefore, the aim of this study was to explore the effects of alternative drainage on acute and chronic pain after video-assisted thoracoscopic surgery (VATS).MethodsNinety-two patients undergoing lung wedge resection were selected and randomly assigned to the conventional chest tube (CT) group and the 7-Fr central venous catheter (VC) group. Next, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain.ResultsNRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 h after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal. Moreover, the number of postoperative salvage analgesics (such as nonsteroidal anti-inflammatory drugs [(NSAIDs]) and postoperative hospitalization days were notably reduced in the VC group compared with the CT group. However, no significant difference was observed in terms of NRS pain scores between the two groups of patients during the follow-up for chronic pain at 3 months and 6 months.ConclusionIn conclusion, a drainage strategy using a 7-Fr central VC can effectively relieve perioperative pain in selected patients undergoing VATS wedge resection, and this may promote the rapid recovery of such patients after surgery.Trial registrationClinicalTrials.gov, NCT03230019. Registered July 23, 2017.

Highlights

Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed
In our previously reported study, we provided evidence demonstrating that the alternative of conventional chest drainage by a 7-Fr double-lumen central venous catheter [17] (CVC) along with a prophylactic air-extraction strategy [18] can be safely applied to patients under lung wedge resection through video-assisted thoracoscopic surgery (VATS) without causing more postoperative complications
94 patients signed written informed consent forms, and the surgeries of 2 patients were temporarily cancelled; 92 patients were randomly assigned to the chest tube (CT) group and VC group

Summary

Introduction

Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. In our previously reported study, we provided evidence demonstrating that the alternative of conventional chest drainage by a 7-Fr double-lumen central venous catheter [17] (CVC) along with a prophylactic air-extraction strategy [18] can be safely applied to patients under lung wedge resection through VATS without causing more postoperative complications. We speculated that the alternative conventional chest drainage strategy of 7-Fr double-lumen CVC may reduce postoperative pain after lung wedge resection through VATS in the present study. To verify this hypothesis, we designed a single-centre, prospective, and randomized controlled trial to explore the effects of different drainage methods on acute and chronic pain in patients after lung wedge resection under VATS

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