title: An audit of pain control pathways following video-assisted thoracoscopic surgery.
abstract: OBJECTIVE
  To compare different modes of pain management following video-assisted thoracoscopic surgery (VATS) to our national standard.
  
  
  METHODS
  This is an audit based on patient's experiences. One hundred consecutive patients who underwent VATS with or without pleurodesis were managed by one of the following pain relief pathways: (A) thoracic paravertebral block + morphine patient-controlled analgesia (PCA), (B) percutaneous thoracic paravertebral catheter +/- morphine PCA, (C) thoracic epidural +/- morphine PCA, (D) morphine PCA alone, and (E) intravenous or subcutaneous morphine as required. Pain score was documented up to four times per day for each patient. The incidence of severe pain was defined as visual analog scale ≥ 7. The results were compared with the standard set by the audit commission for postoperative pain relief in the UK. The mean daily pain scores were calculated retrospectively for all patients.
  
  
  RESULTS
  There were no statistically significant differences in mean daily pain scores irrespective of having a pleurodesis. The percentage of patients experiencing severe pain was 34% [mean visual analog scale = 8 (standard deviation = 1.0)]. This was almost seven times the standard. Among these pathways, B had the least percentage incidence of severe pain (16.7%) followed by A (25.0%) D (33.3%), C (35.7%), and E (52.4%).
  
  
  CONCLUSIONS
  We are not compliant with the standards set by the audit commission. Pain management in theater recovery needs to be targeted. In the light of these results, we recommend the use of percutaneous thoracic paravertebral catheter +/- morphine PCA for postoperative VATS pain relief.
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, Scotland, UK. khoshbinuk@yahoo.co.uk
authors.forename: Espeed
authors.initials: E
authors.lastname: Khoshbin
authors.forename: Ali N
authors.initials: AN
authors.lastname: Al-Jilaihawi
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Scott
authors.forename: Dhruva
authors.initials: D
authors.lastname: Prakash
authors.forename: Alan J B
authors.initials: AJ
authors.lastname: Kirk