Postoperative Pain Intensity After Single-port, Double-port, and Triple-port Video-assisted Lung Lobectomy: A Three-arm Parallel Randomized Clinical Trial

Objective

Video-assisted thoracic surgery (VATS) has evolved from a multiport approach to a one-port approach to reduce the degree of surgical trauma. However, there is no consensus on the number of incisions leading to less postoperative pain. Early postoperative pain was compared after three technical variants of VATS lobectomy under multimodal analgesia, including thoracic epidural analgesia.

Design

This study was designed as a prospective, randomized, controlled clinical trial with three parallel arms.

Setting

Single-center study.

Participants

A total of 112 adult patients with ASA statuses I to III who were scheduled to undergo elective VATS lobectomy for early-stage non–small cell lung cancer were enrolled.

Interventions

Patients were randomly assigned to one of three groups: single-port, double-port, and triple-port VATS lobectomy. The same postoperative analgesia protocol was used in each group.

Measurements and Main Results

The primary outcome was postoperative pain intensity at rest and when coughing within the first 72 hours after surgery. The secondary outcomes were cumulative opioid consumption and the composite rate of postoperative complications. A total of 112 patients were enrolled in the study, 91 of whom completed the study protocol. There were no significant differences between the study groups in terms of pain intensity either at rest (p = 0.319) or when coughing (p = 0.202). There was no difference in the incidence of postoperative complications.

Conclusions

This study revealed no differences in pain intensity in the early postoperative period between three different technical variants of VATS lobectomy when an analgesia protocol based on thoracic epidural anesthesia was used.