The effects of thoracic surgery techniques on postoperative pain and comparison of intercostal interventions.

Surgical treatments of the thorax are one of the most painful surgeries known. Postoperative pain is an important factor affecting treatment success, hospital stay, complications, duration of chest tube placement, and respiratory dynamics. The aim of this study was to compare the effects of analgesic treatments on postoperative pain in patients who underwent surgery with uniportal or biportal VATS (video-assisted thoracoscopic surgery), minithoracotomy, and thoracotomy. This retrospective, single-center observational analytical study was conducted from October 7, 2023, to June 25, 2024, in Department of Thoracic Surgery at Gaziantep City Hospital. Patients who were over 18 years of age, had undergone thoracic surgery were included in the study. Demographic data, comorbidities, surgical techniques, postoperative pain severity according to VAS (visual analogue scale) score, analgesic treatments and interventions, duration of chest tube placement, complications, hospital length of stay were reviewed. A total of 319 patients were examined in the study retrospectively. The gender distribution of the patients were 70.22% male, 29.78% female. Postoperative pain VAS values were 0 to 2 very mild 36.2%, 3 to 4 mild 26.3%, 5 to 6 moderate 27.8%, 7 to 8 severe 11.1%, 9 to 10 very severe 6.2% in uniportal VATS. Pain VAS values for biportal VATS were found as 0 to 2 36.2%, 3 to 4 26.3%, 5 to 6 21.1%, 7 to 8 15.5%, and 9 to 10 18.8%. The VAS values of pain in minithoracotomy were 0 to 2 24.7%, 3 to 4 37.3%, 5 to 6 33.4%, 7 to 8 26.7%, and 9 to 10 18.8%. Postoperative pain VAS values were 0 to 2 very mild 2.9%, 3 to 4 mild 10.1%, 5 to 6 moderate 17.7%, 7 to 8 severe 46.7%, 9 to 10 very severe 56.2% in thoracotomy. Very mild pain value on visual analog scale was related with uniportal VATS, biportal VATS, and minithoracotomy. Very severe pain was only associated with thoracotomy. There was no significant difference in pain between uniportal VATS and biportal. Thoracoscopic surgical techniques (uniportal and biportal VATS) were related with less pain than minithoracotomy and thoracotomy. Intercostal block with uniportal VATS was also associated with less pain than other interventions. Intercostal crush and intercostal ligation were related with lower pain than other interventions in all surgical techniques. No statistically significant difference was found between intercostal crush and ligation on low pain values of visual analog scale.