A Clinical Trial Of Pain-free Management After VATS Pulmonary Lobectomy For Accelerating Rehabilitation

Objective: Lobectomy is one of the most common and representative surgical procedures for the thoracic.In recent years,with the development of minimally invasive surgery techniques and the importance of accelerating rehabilitation,the traditional treatment model was no longer adapt to the current development.Moreover,there were few studies on accelerated rehabilitation after thoracic minimally invasive lobectomy,therefore,we carried out a new management model and made some results.In this study,we investigate the feasibility and security of pain-free management after video-assisted thoracic surgery(VATS)pulmonary lobectomy for accelerating rehabilitation.Methods: The study included 190 patients who underwent VATS pulmonary lobectomy from March 2015 to August 2016 in first affiliated hospital of Soochow university.The 190 patients were randomized divided into four groups,but there were ten patients were excluded: Group A(the blank group),46 cases received conservation management after VATS pulmonary lobectomy and pethidine hydrochloride intramuscular analgesic only when the VAS score?4;Group B(the patient-controlled intravenous analgesia group),47 cases received PCA after surgery and the same way of analgesia with Group A;Group C(the multimodal analgesia group),49 cases received oral or intravenous prophylactic use of nonsteroidal antiinflammatory drugs during perioperative period and intraoperative intercostal nerve block,piperidine hydrochloride was used in the same way as group A;Group D(the treatment group),48 cases improved the chest tube material,placement method and early postoperative extubation on the basis of Group C.The t-test,chi-square test and precise probability method were used to compare the preoperative condition,postoperative VAS values,the dosage of pethidine,the incidence of pulmonary infection and the opioid side effects,the length of stay of four groups.Results: There were no patients in-hospital mortality in this study.There were no statistically significant differences among three groups with general information,time of operation,intraoperative bleeding(P?0.05).The first day visual analogue scale(VAS)of Group D was significantly less than Group A and B(P<0.05)but did not have significant differences with Group C(P?0.05);the twice day VAS of Group D was significantly less than Group A,B and C(P<0.05);the third and fourth day VAS of Group D was significantly less than Group A(P<0.05)but not have significant differences with Group B and C(P?0.05);the fifth day VAS of four groups did not have significant differences(P?0.05).The postoperative hospital stay and perioperative pethidine hydrochloride dosage of Group D were significantly lower than Group A,B and C(P<0.05);the postoperative skin itching and gastrointestinal reactions of Group D were significantly lower than Group A and B(P<0.05),but not have significant differences with Group C(P?0.05);the postoperative pulmonary infection was significantly lower than Group A(P<0.05),while no significant differences with Group B and C(P?0.05);the postoperative arrhythmia and atelectasis did not have significant differences among these four groups(P?0.05).Conclusions: In this study,we found that pain-free management in the VATS pulmonary lobectomy for accelerating rehabilitation was safe and effective,the method could reduce the pain of post-operation,enhanced postoperative recovery and shortened the hospital length of stay,improved patients satisfaction for surgery which was valuable for clinical application.