European Journal of Cardio-Thoracic Surgery, Vol 12, 82-87, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints
M Furrer, R Rechsteiner, V Eigenmann, C Signer, U Althaus and HB Ris
Department of Thoracic and Cardiovascular Surgery, Inselspital, University of Bern, Switzerland.
OBJECTIVE: Two different surgical accesses combined with standard pain
management procedures are compared regarding early and intermediate
pulmonary function and pain relief. METHODS: In a prospective study, 15
consecutive patients undergoing video-thoracoscopy for pulmonary wedge
resection (group 1) were matched to 15 patients undergoing standard
postero-lateral thoracotomy for lobectomy (group 2) according to age,
gender and preoperative pulmonary function. Postoperative pain control
consisted of patient controlled analgesia in group 1 and epidural analgesia
in group 2. Pain intensity was scored from 0-4. The predicted postoperative
pulmonary function (FVC and FEV 1) after lobectomies was calculated from
the preoperative value according to the extent of resection. A clinical
measurement was obtained after a mean follow-up time of 4.2 months.
RESULTS: The ratios of postoperative measured to predicted values of FVC
and FEV1 for group 1 compared with group 2 were 0.64 +/- 0.15 and 0.65 +/-
0.14 compared with 0.60 +/- 0.19 and 0.59 +/- 0.13, resp. (both n.s.) at
the first day postoperative; 0.92 +/- 0.18 and 0.95 /- 0.17 compared with
0.76 +/- 0.20 (P < 0.05) and 0.83 +/- 0.23 (n.s.), resp. at hospital
discharge; 0.98 +/- 0.10 and 0.94 +/- 0.14 compared with 1.01 +/- 0.17
(n.s.) and 1.10 +/- 0.17 (P < 0.05), resp. at follow-up. Pain intensity
score one day after surgery ranged from 0.4 (resting position) to 1.6
(coughing) for group 1, and from 0.3 to 1.2 for group 2. Thirty-six percent
of the thoracoscopy patients and 33% of the thoracotomy group complained of
persistent pain or discomfort on the site of the operation after 3-18
months. CONCLUSION: Post-thoracotomy pain can be effectively controlled
with epidural analgesia and pain intensity is no higher than in patients
after thoracoscopy who are managed with patient controlled analgesia. FVC
is slightly more decreased after thoracotomy during the early postoperative
period. FVC and FEV 1 approach the predicted values after four months in
both groups. The rate of persistent pain is similar after thoracoscopy and
thoracotomy.
