Post-thoracotomy pain syndrome as a risk factor for the development of nosocomial pneumonia

V.E. Khoronenko, D.S. Baskakov, A.S. Malanova, E.A. Mandryka, M.M. Shemetova

Herzen Moscow Research Oncology Institute, the branch of National Medical Research Radiological Center, Ministry of Health of Russia, Moscow

For correspondence: Anna S. Malanova, PhD, Junior Researcher, Department of Anaesthesiology and Resuscitation, Moscow P.A. Herzen — a branch of the Federal Research Center for Radiology Research Center of the Ministry of Health of Russia, Moscow; e-mail: malanova_anna@mail.ru

For citation: Khoronenko VE, Baskakov DS, Malanova AS, Mandryka EA, Shemetova MM. Post-thoracotomy pain syndrome as a risk factor for the development of nosocomial pneumonia. Alexander Saltanov Intensive Care Herald. 2019;1:78–84.

DOI: 10.21320/1818-474X-2019-1-78-84


Background. Pain syndrome is the most common complication of thoracotomy. It is the main reason of discomfort in postoperative period and could impair respiratory function.

The aim of the study. The aim of our study was to analyze the effect of PTPS on pulmonary function and postoperative pneumonia rate in patients underwent open surgery on the lung cancer.

Methods. 300 patients were included in the study operated on in our clinic for lung cancer via thoracotomy approach. All patients were randomly assigned to 3 comparable groups according to the method of anesthesia: thoracic epidural analgesia (HEA), = 100; paravertebral block (PVB), = 100; intercostal block (IRB),= 100. On the 3rd day after the operation, the intensity of the pain syndrome was evaluated by VAS and spirometry was performed.

Results. Analysis of the intensity of postoperative pain syndrome showed the superiority of epidural analgesia over other techniques. In patients with pain syndrome with an intensity of more than 30 mm VAS, the FEV1, VC, and chest excursions were significantly lower than in patients with pain up to 30 mm VAS. The development of pain syndrome of more than 70 mm of VAS led to a significant deterioration in VC rate and chest excursion if compare to patients with AHD 31–70 mm of VAS, which increases the risk of infectious complications.

Conclusion. An optimal antinociceptive protection in the perioperative period improves respiratory function and helps to reduce pulmonary complications rate. The method of choice in open thoracic surgery for lung cancer is a combined general anesthesia with a high thoracic epidural block.

Keywords: oncosurgery, post-thoracotomy pain syndrome, epidural, paravertebral block, intercostal block, postoperative pneumonia

Received: 15.11.2018


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