Multidisciplinary Pulmonary Rehabilitation Combined with Subpleural Anaesthesia After Thoracotomy: Effects on Pain and Respiratory Function

Introduction: Intercostal chest drain used for varied thoracic pathologies causes continuous pain, which impairs ventilatory function. Additional subpleural anaesthesia with 0.25% bupivacaine may improve ventilatory function.Objectives: The aim of the study was to assess rehabilitation based on postoperative pain management with regard to respiratory performance in the postoperative period.Material and methods: The study comprised 100 patients who underwent lung lobe resection. The division into two groups was applied depending on additional anaesthesia. After the procedure, all participants received a unified treatment procedure, and the study group received 0.25% bupivacaine. The outcome measure in both groups was the analysis of the effects of early rehabilitation, consisting of airflow measurement in the lungs before and 1, 3 and 7 days after the surgery. The secondary outcome was the intensity of pain reported by the patients during physiotherapy, measured using the Visual Analogue Scale.Results: The results indicate that the groups were correctly selected. In three subsequent studies, a significant difference appeared in favour of the group with additional subpleural anaesthesia. There were significant differences between each of the two periods. After the resection of the lung lobe, the values may remain at a lower level, but the changes in PEF occurred between the second and third days, the increase being more pronounced in the study group (on average, 68.7 vs. 55.4l/min in the control group). The measurement of pain sensations indicated a beneficial effect of additional anaesthesia.Conclusions: Taking additional anaesthesia into account allowed for improvement the patients’ quality of life. It influenced the improvement of respiratory efficiency, which allowed for better functional fitness and shortening the hospitalisation time. The administration of supplemental anaesthesia significantly enhanced postoperative recovery. It contributed to improved respiratory efficiency, which facilitated better functional status and resulted in shorter duration of hospitalisation.