Comparison of Several Methods for Pain Management After Video-assisted Thoracic Surgery for Pneumothorax

An Observational Study

Pierre-Antoine Allain; Michele Carella; Apostolos C. Agrafiotis; Julien Burey; Jalal Assouad; El-Mahdi Hafiani; Yacine Ynineb; Francis Bonnet; Marc Garnier; Christophe Quesnel


BMC Anesthesiol. 2019;19(120) 

In This Article


Spontaneous pneumothorax (SP) has an overall incidence of 24/100,000 in caucasian males.[1] Recurent and/or complete pneumothorax, compromising normal breathing and oxygenation, requires chest drainage and prevention of further recurrences. Thus, surgical treatment of pneumothorax is indicated in cases of SP relapse, bilateral pneumothorax and persistent air leak. Among the surgical procedures performed to avoid pneumothorax recurrence, the most common is pleurodesis by mechanical abrasion of the parietal pleura. The second most common is pleurectomy followed by chemical pleurodesis by intrathoracic instillation of talc.[2] These procedures are performed either through video-assisted thoracic surgery (VATS) or thoracotomy. Although VATS is associated with less intense postoperative pain,[3] it remains a painful surgical procedure. Indeed, a moderate to intense postoperative pain is reported during the first postoperative 72 h and especially within the first 24 h.[4] The use of loco-regional analgesia is recommended to control postoperative pain after VATS as it allows morphine sparing and facilitates early postoperative rehabilitation.[5] Different loco-regional analgesic techniques could be used to control pain after pneumothorax surgery such as a paravertebral block, an intercostal block, an intrapleural block or more recently a serratus plane block.[5] However, some of them have limitations such as the requirement for multiple injections in the case of an intercostal block. In addition, when a pleurectomy is performed, the loss of the parietal lining of the pleura decreases the efficacy of a paravertebral block.[6] Moreover, the comparative performances of these techniques have been poorly evaluated. Thus, in current practice, there is no gold standard analgesic strategy for pneumothorax surgery.

Every year, more than one hundred patients are referred to the on-call emergency unit for pneumothorax management in our institution, among whom 60% require surgical treatment. Postoperative analgesia is commonly ensured by a loco-regional analgesic technique, but the choice of technique remains at the discretion of the attending anesthesiologist. Consequently, we evaluated the efficacy and the side effects of several techniques in a cohort of patients scheduled for VATS to treat SP.