In a study presented at the 2015 annual meeting of the Canadian Anesthesiologists' Society, patients undergoing open thoracic surgical procedures had much higher rates of pain six months after surgery than those who had undergone minimally invasive video-assisted thoracoscopic surgery.
Dina Aboutouk, MD, a resident at McMaster University in Hamilton, Ontario, said the incidence of persistent pain after thoracic surgery is quite high, ranging from 44 percent to 67 percent.
Dr. Aboutouk and her colleagues contacted 353 adult patients who had undergone thoracic surgery at McMaster. Each patient was mailed a questionnaire about the presence or absence of pain, its nature and other pertinent factors; nonresponders were reminded by telephone. Demographic, surgical and postoperative analgesia details were collected from health records and institutional databases. Patients were divided into two groups according to surgery type. Data were analyzed using multivariate logistic regression, with adjusted odds ratios for primary and secondary outcomes.
There were 106 people who completed surveys and included in the final analysis.
1. While both groups had lobectomies as the predominant type, the diagnosis of cancer was statistically more common in the open-surgery group. In addition, the use of epidural analgesia was greater in the open-surgery group than the VATS group.
2. Logistic regression analysis indicated a significantly lower incidence of persistent postthoracotomy pain in the VATS group. The incidence of persistent pain was approximately 55 percent in the open-surgery group and 37 percent in the VATS group.
3. The incidence of neuropathic pain was 26 percent in the open group and approximately 7 percent for the minimally invasive group, and is much lower than what's reported in the literature, which ranges anywhere from 35 percent to 85 percent.
4. The diagnosis of cancer and history of previous chronic pain were significantly predictive for the development of persistent postthoracotomy pain. Thoracic epidural analgesia and sex were found to have no effect on the incidence of persistent pain, although the findings did not reach the level of significance.
5. Total incidence of pain in both groups was 44 percent, and even though minimally invasive surgery was clearly superior, 36 percent of the patients in the VATS group still ended up with persistent pain.
6. In conclusion, the difference between VATS and open surgery was statistically significant for persistent pain after adjusting for covariates.