Evaluation of postoperative pain relief after video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax

BACKGROUND: We have investigated correlation between postoperative pain and chest tube insertion after video-assisted thoracoscopic surgery (VATS) for patients with spontaneous pneumothorax, and have evaluated preemptive analgesia by intercostal nerve block (ICB) using bupivacaine. METHODS: Thirty patients received VATS for spontaneous hemi-pneumothorax. There were two groups of the patients; Group CT received chest tube before the operation, and the Group NCT received no chest tube. Both groups received general anesthesia combined with ICB by 0.25% bupivacaine at the surgical region before operation. Postoperative pain was assessed using visual analogue scale (VAS scale: 0-10) and the need for additional supplemental analgesics before the operation, and at 6 and 24 hours after the operation, and at 3, 7, 14, and 30 days after the operation. RESULTS: Visual analogue scale in Group NCT before the operation, and at 24 hours, 3, 7, 14, and 30 days after the operation was significantly lower than that of Group CT. Analgesic requirements were significantly lower in the Group NCT than in the Group CT. CONCLUSIONS: We should avoid the insertion of a chest tube before the operation as much as possible. Furthermore early operation and intercostal nerve blockade before the operation were useful to prevent postoperative pain and its shift to chronic post thoracostomy pain.