THORACOTOMY AND THORACOSCOPY - POSTOPERATIVE PULMONARY-FUNCTION, PAINAND CHEST-WALL COMPLAINTS

Objective: Two different surgical accesses combined with standard pain management procedures are compared regarding early and intermediate p ulmonary function and pain relief. Methods: In a prospective study, 15 consecutive patients undergoing video-thoracoscopy for pulmonary wedg e 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 ana lgesia in group 2. Pain intensity was scored from 0-4. The predicted p ostoperative pulmonary function (FVC and FEV 1) after lobectomies was calculated from the preoperative value according to the extent of rese ction. A clinical measurement was obtained after a mean follow-up time of 4.2 months, Results: The ratios of postoperative measured to predi cted values of FVC and FEV1 for group 1 compared with group 2 were 0,6 4 +/- 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), r eap. at follow-up. Pain intensity score one day after surgery ranged f rom 0.4 (resting position) to 1.6 (coughing) fur group I, and from 0.3 to 1.2 for group 2. Thirty-six percent of the thoracoscopy patients a nd 33% of the thoracotomy group complained of persistent pain or disco mfort on the site of the operation after 3-18 months, Conclusion: Post -thoracotomy pain can be effectively controlled with epidural analgesi a and pain intensity is no higher than in patients after thoracoscopy who are managed with patient controlled analgesia. FVC is slightly mor e decreased after thoracotomy during the early postoperative period, F VC and FEV 1 approach the predicted values after four months in both g roups. The rate of persistent pain is similar after thoracoscopy and t horacotomy. (C) 1997 Elsevier Science B.V.