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Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In view of the increasing development of laparoscopic surgery and hoping to minimize thoracotomy's risks, we had the idea to perform pleurectomy as a treatment of Spontaneous Pneumothorax (S.P.) through video thoracoscopy. The operation was performed under general endobronchial anesthesia, the patient placed in the posterolateral thoracotomy position. Three trocars inserted through the 5th, 7th and 9th intercostal space, allowed the introduction of non specific thoracoscopic instruments similar to those used in laparoscopic surgery. The apical pleurectomy was delimited by the 6th rib, the internal thoracic vessels, the costovertebral sulcus and the first rib. Blebs and small bullae are now transected with application of the "EndoGIA 30". Pleural cavity was drained by F28 ans F32 tubes through the lower orifices. This procedure was performed in 18 patients presenting 20.S.P.. Operative indications were: persistent air link (7 cases), recurrence (9 cases), bullae with bridle and or anterior thoracotomy for S.P. (4 cases). One bleeding of 200 ml from a wounded intercostal vessel ligated with a clip was the sole operative hitch. Operative duration decreased from two to one hour. Average drainage duration was 3.5 dys and hospital stay 4.5 days. There was no death nor immediate complications. Post-operative pain was judged in all cases less intensive than that experienced after pleurectomy with thoracotomy. This original procedure is the first described as entirely performed through thoracoscopy with non specific instruments and hence economic impact.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Upper parietal pleurectomy with resection of bullae by thoracoscopy in spontaneous pneumothorax. New perspectives from preliminary results in 20 cases]. 130 25

Bilateral apical bullae have previously been approached by staged or one-staged bilateral thoracotomy. In a 26-year-old male with bilateral primary spontaneous pneumothorax, bilateral apical bullae were successfully removed with thorough pleural abrasion using imaged thoracoscopic surgery in one operation. Postoperative pain was markedly reduced, pulmonary toilet was easily accomplished and cosmetic appearance of the scar satisfactory. Bilateral bullectomy and pleurodesis using imaged thoracoscopic surgery can, therefore, provide a simpler and safer option for bilateral pneumothorax.
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PMID:One-stage operation for bilateral spontaneous pneumothorax using imaged thoracoscopic technique: case report. 848 50

Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved. In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27 +/- 8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43 +/- 21 yrs) with persistent SSP. TT proved to be equally effective in achieving pleurodesis in both groups; there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p > 0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p = 0.004) and a longer postoperative chest tube drainage time (35.5 +/- 18 vs 24.9 +/- 3.2 hrs; p = 0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7 +/- 2 vs 3.2 +/- 0.5 days; p < 0.0001). Postoperative pain (90 vs 43%; p < 0.0001) and fever (65 vs 17%; p = 0.001) were more frequent in the PSP group than in the SSP group. There were no major peri- or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax.
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PMID:Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax. 904 42

The surgical requirement for thoracoscopy is a good view of the contents of the thorax. This is achieved by capitalizing on natural consequences and the skills of anaesthesiologists to produce a pneumothorax and collapse the ipsilateral lung--a process that is commonly enhanced by insufflating carbon dioxide. Insufflating CO2 to actively promote lung collapse creates the dynamics of a tension pneumothorax. Complications are clinically insignificant if CO2 is used judiciously. There is a body of experience using ordinary endotracheal tubes and two-lung ventilation. Techniques of one-lung ventilation are more widely reported. All the factors known to contribute to the significant increase in shunt fraction associated with one-lung ventilation apply. The manoeuvre of collapsing a lung is no longer regarded as benign. Chemical attempts to produce a reversible post-pneumonectomy pulmonary circulation have not been shown to be an improvement. Post-operative pain can be severe. The mechanism is not defined but it differs from that associated with thoracotomy. Epidural analgesia and opioids may be required. Chronic pain syndromes have been described as complications.
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PMID:Anaesthesia for thoracoscopic surgery. 1249 43