title: Sternotomy or bilateral thoracoscopy: pain and postoperative complications after lung-volume reduction surgery.
abstract: OBJECTIVE
  Video-assisted thoracoscopic surgery (VATS) and median sternotomy (MS) are two approaches in lung-volume reduction surgery (LVRS). This study focused on the two surgical approaches with regard to postoperative pain.
  
  
  METHODS
  In this prospective, non-randomized study, pain was measured preoperatively and postoperatively using the visual analog scale (VAS) and the brief pain inventory (BPI). Incentive spirometry (IS) assessed restriction of the thoracic cage due to pain. Factors associated with treatment complications, medication usage, hospital stay, operating times, and chest-tube duration differences were examined between groups.
  
  
  RESULTS
  Of 85 patients undergoing LVRS, 23 patients underwent reduction via MS and 62 patients via bilateral VATS. VAS scores revealed no difference in postoperative pain except for VAS scores on days 6 (PM) and 7 (PM). BPI scores yielded higher scores in the VATS group on postoperative day (POD) 1 in the reactive dimension, but no other overall differences. MS patients receiving tramadol consumed a higher mean amount than VATS patients on POD 5 and POD 6. IS change from baseline to postoperative were similar between groups, and increased pain correlated with decreased IS scores on POD 1. Chest-tube duration, complications, and pain medication were similar between groups.
  
  
  CONCLUSIONS
  Bilateral VATS and MS offer similar outcomes with regard to postoperative pain and complications. These results suggest that the choice of LVRS operative approach should be dependent on disease presentation, surgeon expertise, and patient preference, not based upon differences in perceived postoperative pain between MS and bilateral VATS.
authors: Southern Illinois University School of Medicine, Division of Cardiothoracic Surgery, 701 N, First Street, Springfield, IL 62794-9638, USA. tboley@siumed.edu
authors: Theresa M
authors: TM
authors: Boley
authors: Adam J
authors: AJ
authors: Reid
authors: Blaine T
authors: BT
authors: Manning
authors: Stephen J
authors: SJ
authors: Markwell
authors: Christina M
authors: CM
authors: Vassileva
authors: Stephen R
authors: SR
authors: Hazelrigg
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