Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax.
OBJECTIVE
Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or complicated primary spontaneous pneumothorax (PSP). However, a proportion of patients still complains of chronic pain or discomfort after VATS pleurodesis. We aimed to investigate if paresthesia is a distinct component of the post-operative discomfort in patients receiving VATS for PSP.


METHODS
Telephone interviews were conducted with 52 patients who had received VATS pleurodesis for PSP in our institute during a defined 24 month period. A standardized questionnaire was used to identify paresthetic discomforts which the patients themselves could distinguish from their wound pain. Responses were obtained from 51 patients (42 male, 9 female) with a mean age of 24.1 years (range 14-63 years), giving a response rate of 98.0%.


RESULTS
With a median observation time of 19 months (range 2-24 months), 27 patients (52.9%) reported experiencing paresthesia as a post-operative complication distinct from their wound pain. The most commonly described characteristics of the paresthesia were 'pins and needles' (37.0%), 'numbness' (25.9%) or a sensation of abnormal 'swelling' in the chest wall (11.1%). Although only two of the affected patients (7.4%) described the paresthesia as 'severe', consequent functional disturbances in daily life were noted by seven patients (25.9%), and 11 patients (40.7%) actively sought medical or alternative, holistic therapies to relieve the paresthesia. Eight (21.0%) of the 38 patients followed-up for over 12 months after surgery still experienced the paresthesia.


CONCLUSIONS
Although it should not detract from the proven advantages of VATS, paresthesia in the chest wall represents a distinct but previously overlooked post-VATS complication. It is a potential source of significant post-operative morbidity, and may run a chronic course in some patients. Further study is warranted to elucidate its mechanisms and optimum management.
Sihoe
Alan D L
AD
Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Au
Sylvia S W
SS
Cheung
Mabel L
ML
Chow
Ivan K L
IK
Chu
Ka Man
KM
Law
Chun Yat
CY
Wan
Maxim
M
Yim
Anthony P C
AP
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology*; D011030:Pneumothorax / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D035441:Thoracic Wall