Thoracic surgery, Acute pain, Analgesic regimen I read with great interest the article by Li et al.  in a recent issue of the journal. The authors performed a retrospective study on 285 patients to compare single-port video-assisted thoracic surgery with the multi-port variants in terms of short-term perioperative outcomes and concluded that single-port video-assisted thoracic surgery has potential advantages of less postoperative pain when compared with multi-port techniques. The authors should be congratulated for performing a study on an important topic (e.g. acute pain) in patients undergoing thoracic surgery [2,3]. The current emphases on the need to improve postsurgical pain and reduce opioid intake makes the topic very relevant in perioperative medicine [4,5]. Although the study by Li et al. was well conducted, there are some questions regarding the study that need to be clarified. First, it is not clear whether the intraoperative analgesic regimens were standardized for all patients as this can substantially affect the study outcomes. Second, it is unclear whether any patient received a thoracic epidural as part of their analgesic management, which is regarded as the standard of care for postoperative pain control in these types of surgical cases. Finally, although the patients were recruited consecutively, it is not clear how each patient was allocated to the study groups (e.g. surgeon’s preference and disease extension) as this can result in a significant selection bias for the study outcomes. I would welcome some comments by the authors as this would help to further substantiate the findings of this important clinical study. REFERENCES 1 Li Q , Sihoe A , Wang H , Gonzalez-Rivas D , Zhu Y , Xie D et al. Short-term outcomes of single- versus multi-port video-assisted thoracic surgery in mediastinal diseases . Eur J Cardiothorac Surg 2018 ; 53 : 216 – 20 . Google Scholar CrossRef Search ADS PubMed 2 Niraj G , Kelkar A , Kaushik V , Tang Y , Fleet D , Tait F et al. Audit of postoperative pain management after open thoracotomy and the incidence of chronic postthoracotomy pain in more than 500 patients at a tertiary center . J Clin Anesth 2017 ; 36 : 174 – 7 . Google Scholar CrossRef Search ADS PubMed 3 Fiorelli A , Santini M. Total intravenous anaesthesia with local anaesthesia for controlling pain after spontaneous ventilation video-assisted thoracic surgery: is it a viable strategy? Eur J Cardiothorac Surg 2017 ; 52 : 200. Google Scholar CrossRef Search ADS PubMed 4 Kıtlık A , Erdogan MA , Ozgul U , Aydogan MS , Ucar M , Toprak HI et al. Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: a prospective, randomized, double-blinded clinical trial . J Clin Anesth 2017 ; 37 : 103 – 7 . Google Scholar CrossRef Search ADS PubMed 5 Chong MA , Wang Y , Dhir S , Lin C. Programmed intermittent peripheral nerve local anesthetic bolus compared with continuous infusions for postoperative analgesia: a systematic review and meta-analysis . J Clin Anesth 2017 ; 42 : 69 – 76 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Sep 1, 2018
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