EARLY POSTOPERATIVE STRESS - VIDEO-ASSISTED WEDGE RESECTION LOBECTOMYVS CONVENTIONAL AXILLARY THORACOTOMY/

Postoperative pain is a major cause of ineffective breathing after lun g surgery, predisposing patients to hypoxemia. Because potent analgesi cs Like opioids depress ventilation and other analgesic techniques are time-consuming, efficient postoperative pain therapy is difficult. Th erefore, a less painful surgical approach could be beneficial, Forty-s even patients with diagnosis of a pulmonary nodule were prospectively studied, Patients were assigned to a video-assisted thoracic surgery ( VATS) group (n=22) or a group undergoing axillary thoracotomy (n=25), Visual analogue scale (VAS) scores, plasma glucose levels, plasma epin ephrine and plasma norepinephrine levels, as well as arterial oxygen ( PaO2) and carbon dioxide (PaCO2) tension were determined the day befor e surgery, and 3, 15, 24, 48, and 72 h after surgery. Postoperative pi ritramide (a synthetic morphine compound) demand was recorded, VAS val ues were significantly lower (p<0.05) during the whole observation per iod in the VATS group, Significantly higher epinephrine levels were ob served 3 and 15 h after surgery (267.4+/-28 vs 111.8+/-13 ng/L; p<0.01 ; and 176.6+/-46.5 vs 96+/-14.5 ng/L; p<0.05) in the thoracotomy group , whereas there was no significant difference in norephinephrine level s. Piritramide demand was significantly (p<0.05) reduced in the VATS g roup throughout the whole observation period. There mas no difference in PaCO2 values but PaO2 values were higher in the VATS group over 72 h, with maximum differences occurring at 15 h after operation: 60.9+/- 1.9 vs 49.2+/-2.4 mm Hg (p<0.01). In conclusion, the videoendoscopic a pproach is associated with less postoperative pain and better oxygenat ion than traditional surgical approaches.