Pre-emptive local anesthesia for needlescopic video-assisted thoracic surgery: a randomized controlled trial

Area of Science:

• Thoracic Surgery
• Pain Management
• Anesthesiology

Background:

• Pre-emptive wound infiltration with local anesthetics is suggested to reduce post-operative pain in various surgical fields.
• Limited research exists on its efficacy in video-assisted thoracic surgery (VATS).

Purpose of the Study:

• To evaluate the effectiveness of pre-emptive local anesthesia in reducing post-operative pain after needlescopic VATS sympathectomy.
• To conduct the first randomized trial assessing pre-emptive local anesthesia in VATS.

Main Methods:

• A prospective, randomized trial involving 31 patients undergoing bilateral needlescopic VATS sympathectomy.
• Each patient served as their own control, with one side receiving bupivacaine infiltration and the other saline before incision.
• Pain severity was assessed using a visual analog scale (VAS) at 4 hours, 1 day, and 7 days post-surgery.

Main Results:

• Significant reduction in wound pain at 7 days post-surgery was observed on the pre-emptively anesthetized side (p=0.039).
• A trend towards reduced pain was noted at earlier time points, though not statistically significant.
• Chest wall paresthesia occurred in 19.4% of patients but was not affected by the pre-emptive anesthesia.

Conclusions:

• Pre-emptive wound infiltration with local anesthetic is a potentially effective method for reducing post-operative wound pain in needlescopic VATS.
• The overall post-operative discomfort in these VATS procedures was mild.