LAUSR

Introduction Video-assisted thoracoscopic surgery (VATS) is the most widely used technique in thoracic surgery. However, preoperative pleural adhesion is a major obstacle in VATS and pleural adhesiotomy could aggravate a severe pain after surgery. In this study, we evaluated the usefulness of chest ultrasound to predict preoperative pleural adhesion and postoperative severe pain in VATS. Methods This study was a double blind observational study. Before induction of anaesthesia, 54 patients undergoing VATS were evaluated by using chest ultrasonography. During spontaneous and forced breathing, the sliding of visceral pleura was assessed by 7-Mhz linear transducer at three points (upper and lower blue points and phrenic point of the operating side). Presence of pleural adhesion was confirmed by surgeon through thoracoscopy at same points. Based on the existence of pleural adhesion in chest ultrasound, all of patients were assigned to two groups. Postoperative pain was assessed by numeric rating scale (NRS) and consumption of opioid until postoperative 24 hours. Results Preoperative chest ultrasonography to find pleural adhesion demonstrated a sensitivity of 53.3% [95% confidence interval; 0.38-0.68], a specificity of 96.5% [0.91-0.99], an accuracy of 84.3% [0.78-0.90], a positive predictive value of 85.7% [0.67-0.96], and a negative predictive value of 84.0% [0.77-0.90]. Patients with severe pain (NRS > 6) was not different significantly (adhesion group vs. free group; 57.9% vs. 64.7%; p = 0.624). Consumption of opioid did not show difference statistically (fentanyl equivalent dose, mcg; median [interquartile range], 530 [390-580] vs. 435 [375-570]; p = 0.594). Discussion Chest ultrasonography showed usefulness to predict pleural adhesion. It could help to decide an approach plan (VATS or open thoracotomy) in thoracic surgery. However, it would not be helpful to predict a postoperative severe pain.