Alternative Thoracic Drainage Strategy Alleviates Perioperative Pain After Lung Wedge Resection: A Randomized Controlled Trial

doi:10.21203/rs.3.rs-142647/v1

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Alternative Thoracic Drainage Strategy Alleviates Perioperative Pain After Lung Wedge Resection: A Randomized Controlled Trial

https://doi.org/10.21203/rs.3.rs-142647/v1

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Background: Indwelling thoracic drainage tube is one of the leading causes of postoperative pain after thoracotomy. Currently, limited evidence exists on evaluating the acute and chronic pain resulting from chest tube after video-assisted thoracic surgery (VATS). Herein, we intended to explore an alternative drainage method and its impact on acute and chronic pain after VATS.

Methods: For this purpose, ninety-two patients undergoing lung wedge resection were selected and randomly assigned to conventional chest tube (CT) group and venous catheter (VC) group, respectively. Then, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain.

Results: Our data showed that the NRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 hours after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal), respectively. Moreover, the number of postoperative salvage analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) used in the VC group and postoperative hospitalization days were notably reduced 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.

Conclusion: Taken together, the drainage strategy mentioned in this article is effective in relieving perioperative acute pain and reducing the use of salvage analgesics in selected patients undergoing VATS wedge resection, which is beneficial for the rapid recovery of patients after surgery.

Trial registration: ClinicalTrials.gov, NCT03230019. Registered July 23, 2017

Anesthesiology & Pain Medicine

thoracic drainage tube

double lumen central venous catheter

video-assisted thoracic surgery

acute pain

chronic pain

Table 1. The demographics and clinical characteristics between the two groups

	CT group （n=42）	VC group (n=38)	P value
Age, years	54.7 ± 11.6	53.6 ± 9.2	0.646
Sex			0.644
female	28	23
male	14	15
BMI(Kg/m²)	23.1 ± 2.4	22.3 ± 2.7	0.169
Classification of ASA			1.000
I	39	35
II	3	3
Surgical incision length, cm	3.6 ± 0.5	3.5 ± 0.6	0.713
Surgery time, median(25th-75th percentile), minutes	60（50-88）	60（50-89）	0. 927
Resection length, median (25th-75th percentiles), mm	135(120-180)	135(120-180)	0. 636

Data are presented as mean±SD, median (range).

CT: Chest Tube

VC: Venous Catheter

BMI: Body Mass Index

ASA: American Society of Anesthesiologist

Table 2. Patients outcomes of perioperative

	CT group （n=42）	VC group (n=38)	95% confidence interval	P value
Postoperative 6 hours (NRS)	2.9 ± 0.8	2.3 ± 0.9	-	0.001
POD1 (NRS)	2.8 ± 0.8	2.6 ± 0.9	-	0.026
POD2 (NRS)	2.7 ± 0.7	2.2 ± 0.8	-0.75 to -0.11	0.009
Drainage tube removal (NRS)	3.3 ± 0.7	2.8 ± 0.7	-	0.003
Discharge (NRS)	1.5 ± 0.6	1.3 ± 0.7	-0.44 to 0.12	0.267
Intravenous analgesia (days)	1.3 ± 0.6	1.1 ± 0.4	-0.41 to 0.02	0.069
Salvage analgesics
NSAIDs	3.0 ± 2.0	2.0 ± 1.5	-1.72 to -0.13	0.023
Opioid	0.5(0-1)	1.0(1-2)	-	0.545
Postoperative chest tube/ catheter removal (days)	1.7 ± 0.7	1.7 ± 0.9	-	0.416
Postoperative hospitalization (days)	3.2 ± 1.2	2.7 ± 1.4	-	0.001
POM1 (NRS)	1.1 ± 0.5	0.9 ± 0.5	-	0.182

Data are presented as mean ± SD, median (range).

POD: Postoperative Day

NRS: Numeric Rating Scale

NSAIDs: Nonsteroidal Antiinflammatory Drugs

POM: Postoperative Month

Table 3. Three- and 6-month follow-up for chronic pain assessments

	POM3			POM6
	CT group （n=40）	VC group (n=35)	P value	CT group （n=36）	VC group (n=32)	P value
Chronic pain positive (%)	10(25)	7(20)	0.783	7(19.4)	4(12.5)	0.521
Pain characteristic
tingling (%)	2 (5)	3 (8.6)	0.659	2 (5.6)	1 (3.1)	1.000
numbness (%)	3 (7.5)	2 (5.7)	1.000	3 (8.3)	1 (3.1)	0.616
Paresthesia (%)	5 (12.5)	2 (5.7)	0.438	2 (5.6)	2 (6.3)	1.000

Data are presented as n (%). POM: Postoperative Month

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Editorial decision: Major revision
10 Jun, 2021
Reviews received at journal
26 May, 2021
Reviewers agreed at journal
16 May, 2021
Reviews received at journal
22 Apr, 2021
Reviewers agreed at journal
12 Apr, 2021
Reviewers invited by journal
07 Feb, 2021
Editor assigned by journal
07 Feb, 2021
Editor invited by journal
18 Jan, 2021
Submission checks completed at journal
18 Jan, 2021
First submitted to journal
07 Jan, 2021

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Alternative Thoracic Drainage Strategy Alleviates Perioperative Pain After Lung Wedge Resection: A Randomized Controlled Trial

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