Chest Tubes Are Painful

When patients wake up from lung surgery, the main complaint is pain in the chest from the chest tube. Implementing an enhanced recovery after surgery program with multimodal pain medication has helped keep the pain to a manageable level. 1 Del Calvo H. Nguyen D.T. Meisenbach L.M. et al. Pre-emptive pain management program is associated with reduction of opioid prescription after minimally invasive pulmonary resection. J Thorac Dis. 2020; 12: 1982-1990 Crossref PubMed Scopus (6) Google Scholar Still, the discomfort from the chest tube persists until it is removed. Laven and colleagues 2 Laven I.E.W.G. Franssen A.J.P.M. van Dijk D.P.J. et al. A no-chest-drain policy after video-assisted thoracoscopic surgery wedge resection in selected patients: our 12-year experience. Ann Thorac Surg. 2023; 115: 835-844 Abstract Full Text Full Text PDF Scopus (3) Google Scholar performed a retrospective analysis of the no-chest-tube placement policy after lung surgery in their paper in this issue of The Annals of Thoracic Surgery, “A No-Chest-Drain Policy After Video-assisted Thoracoscopic Surgery Wedge Resection in Selected Patients: Our 12-Year Experience.” The surgeons in the group selected patients who did not have emphysema, severe pleural adhesion, or parenchymal disease who underwent video-assisted thoracic surgery pulmonary wedge resection and placed no chest tube at the end of the case. Their group found that the drainless group needed intervention 5% of the time for pneumothorax, pleural effusion, or atelectasis. The drainless group had less need for pain medication and a shorter length of stay. This is one of the larger series of patients who underwent wedge resection without a chest tube. The largest retrospective series with 132 patients who underwent wedge resection without a chest tube showed that they had a reintervention rate of 0.7%. 3 Nakashima S. Watanabe A. Mishina T. et al. Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung. Surg Today. 2011; 41: 774-779 Crossref PubMed Scopus (37) Google Scholar A No-Chest-Drain Policy After Video-assisted Thoracoscopic Surgery Wedge Resection in Selected Patients: Our 12-Year ExperienceThe Annals of Thoracic SurgeryVol. 115Issue 4PreviewPostoperative pleural drainage omission after video-assisted thoracoscopic surgery (VATS) for wedge resections may facilitate faster recovery. This retrospective cohort study presents our 12-year experience with omitting thoracic drainage in patients who underwent a VATS wedge resection, aiming to assess its safety and efficacy. Full-Text PDF