[Postoperative Pain after Hybrid Video-assisted Thoracic Surgery].

BACKGROUND: Hybrid video-assisted thoracic surgery (hybrid VATS), combining television monitoring and direct visualization through mini-thoracotomy, has been established as a secure and minimally invasive operation for lung cancer. This study aimed to determine postoperative pain levels after hybrid VATS in which intraoperative internal intercostal nerve block is performed. We also examined whether additional use of postoperative continuous infusion of fentanyl improves postoperative pain control.

METHODS: Data from 131 patients undergoing hybrid VATS were retrospectively analyzed. Thoracoscopic, internal intercostal nerve block was performed at the end of the procedure. Postoperative pain levels after hybrid VATS, and the impact of postoperative continuous infusion of fentanyl on postoperative pain levels and the incidence of postoperative nausea and vomiting (PONV) were examined.

RESULTS: 46.6% of patients experienced severe postoperative pain (numerical rating scale 7-10) after hybrid VATS. Postoperative continuous infusion of fentanyl was not associated with reduction in postoperative pain score, but was independently associated with PONV [odds ratio 3.44 (1.52-8.20); P = 0.0027].

CONCLUSIONS: Intraoperative internal intercostal nerve block did not provide sufficient analgesia after hybrid VATS. Additional use of postoperative continuous infusion of fentanyl did not reduce pain score, but increased the incidence of PONV.