A Preliminary Study On Perioperative Pain Management In Video-assisted Thoracic Surgery

Objective: With the rapid development of Video-assisted Thoracoscopic Surgery(VATS)and the application and popularization of the concept of Enhanced Recovery After Surgery(ERAS),the traditional concept of analgesic treatment has been unable to meet the needs of perioperative pain management.The purpose of this study is to investigate the feasibility and safety of optimizing VATS perioperative pain management in ERAS.Method: Analysis of 120 patients undergoing lobectomy via VATS from August 2018 to August 2019 in China-Japan Union Hospital of Jilin University.All patients were randomly divided into traditional pain management group(the group A,n=30),preoperative pain education group(the group B,n=30),regional nerve block group(the group C,n=30)and perioperative optimized pain management group(the group D,n=30).Perioperative pain management was optimized by preoperative pain education,intraoperative thoracoscopic direct vision of Intercostal Nerve Block(ICNB)and incision infiltration of local anesthesia.Postoperative pain was evaluated by Numerical Rating Scale(NRS).Record each postoperative day 1(T1),day 2(T2),day 3(T3),day 5(T5) and day 7(T7)NRS score,drainage tube removal time,hospitalization time after operation,the postoperative complications and postoperative analgesia remedying measures for comparative analysis,in order to investigate the clinical application value of VATS perioperative pain management.Result: NRS score in group D was significantly lower than that in group A at the T1,T5 and T7 times(P < 0.05).NRS score in group C was significantly lower than that in group A at the T1 and T7 times(P < 0.05).Compared with group B,NRS score in group C and group D were significantly reduced at the T1 time(P < 0.05).There was no significant difference in NRS score at the T2 and T3 times among the four groups(P > 0.05).Compared with group A and group B,the indwelling time of drainage tube in group D was significantly reduced(P < 0.05).Compared with group A,the hospitalization time after operation in group C and group D were significantly shortened(P < 0.05).The frequency of postoperative remedial analgesia in group C and group D were significantly lower than that in group A(P < 0.05).The frequency of postoperative remedial analgesia in group C was significantly lower than that in group B(P < 0.05).Compared with group A,the complication rate of group C and group D were significantly reduced(P < 0.05).Conclusion: According to the preliminary clinical study,the optimized VATS perioperative pain management can effectively alleviate perioperative pain of patients,shorten the indwelling time of drainage tube,hospitalization time after operation and reduce the incidence of postoperative complications.It is beneficial to enhance recovery after surgery of patients,which is worthy of further discussion and research.The effect of preoperative pain education on perioperative pain management is not enough,so it should be combined with other analgesic measures to improve the analgesic effect.Intraoperative thoracoscopic direct vision of ICNB and incision infiltration of local anesthesia are safe and simple,the analgesic effect is accurate,but the maintenance time is short,which needs to be further improved.