title: Comparison of Postoperative Pain after Different Thoracic Surgery Approaches as Measured by Electrical Stimulation.
abstract: BACKGROUND
  Postoperative pain is commonly evaluated using the numerous rating scale (NRS), visual analogue scale, or pain scale; however, these assessments are easily affected by various subjective factors. We measured the degree of postoperative chest pain among different thoracic surgery approaches using NRS and electrical stimulation measurements.
  
  
  METHODS
  Seventy patients who underwent lobectomy or segmentectomy were enrolled. Concomitant with NRS, pain scores were quantitatively measured on postoperative day 2 using an electrical neurostimulator to compare the degree of pain among three different surgical approaches: pure video-assisted thoracic surgery (VATS), hybrid VATS, and conventional thoracotomy. The risk factors associated with postoperative pain were also analyzed.
  
  
  RESULTS
  Thirty patients underwent lung resection with pure VATS, while 30 had hybrid VATS, and 10 had conventional thoracotomy. Among the three surgical approaches, analyzing the pain score indicated statistically significant differences (pure, 159.50 ± 26.22; hybrid, 269.36 ± 30.49; thoracotomy, 589.40 ± 141.11; p = 0.003); however, NRS did not obtain a statistically significant difference between the three approaches (pure, 4.26 ± 0.27; hybrid, 4.96 ± 0.30; thoracotomy, 5.50 ± 0.68; p = 0.105). A multivariate analysis showed that the surgical approach was an independent risk factor for postoperative pain as determined by the pain score (pure vs. hybrid, p = 0.076; pure vs. thoracotomy, p < 0.001).
  
  
  CONCLUSIONS
  For lung surgery, the differences in surgical approach were an independent risk factor for postoperative pain. In the early postoperative period, pure VATS was shown to be the least painful of the three surgical approaches.
authors.affiliation: Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsubokawa
authors.affiliation: Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Harada
authors.affiliation: Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Takenaka
authors.affiliation: Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Misumi
authors.affiliation: Department of Respiratory Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome