ABSTRACT
Introduction: Although primary spontaneous pneumothorax is a common disease in young adults, each thoracic surgery department performs different procedures for its management. Aim: The optimal time of postoperative mobilization is not yet standardized in lung surgery. Material and methods: This study included male patients with a primary spontaneous pneumothorax who underwent wedge resection of the upper lobe of the lungs via uniportal video-assisted thoracoscopic surgery. Patients were encouraged to stand up within the first postoperative hour. Mobilization was defined as standing and walking at least 100 m from the bed. If orthostatic hypotension occurred, mobilization was postponed for 30 min. Immediately after surgery, intravenous fluids were discontinued, and patients were instructed to drink water. The analgesic treatment needs, length of hospitalization, drainage, and discharge times were recorded. Results: A total of 43 patients were operated on by the same surgeon. All operations were ended with uniportal video-assisted thoracoscopic surgery. Wedge resection is most commonly indicated for recurrent ipsilateral pneumothorax. Patients walked 345 (range: 150-510) m on the department corridor following bed rest. Paracetamol (2 g) and dexketoprofen (100 mg) were intravenously administered as postoperative analgesia to 76.7% of patients. Narcotic drugs were not needed. Conclusions: Mobilization was recommended in the first hour following uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.
ABSTRACT
Thoracic incisions are very painful and complicated incisions. Many analgesic drugs including opioids are used to relieve pain in patients. We hypothesized that early mobilization and patient-centered strategy after lung resection reduce the incidence of perioperative complications and postoperative pain. We conducted a retrospective study on patients who underwent lung resection via thoracotomy and were mobilized in the first 4 h postoperatively. Mobilization was defined as standing and walking at least 100 m from the bed. If orthostatic hypotension occurred, mobilization was postponed for 30 min. Analgesic treatment needs, walking distance, co-morbidity, hospitalization, postoperative complications within 30 days, and drainage and discharge times of patients were analyzed. The lobectomy with thoracotomy was performed in 48 patients. Thirty-six patients were male. The rate of additional systemic diseases was 58.3%. Forty patients walked in the first 3 h postoperatively. The mean walking distance was 140 ± 38.5 m. The rate of orthostatic hypotension was 8.3%. The routine analgesic treatment included intravenous paracetamol 3 g and dexketoprofen 100 mg daily. In this study, 18% of patients received narcotic analgesics. Thromboembolic event and arrhythmia did not develop in any patient. The most common complication was prolonged air leaks (18.8%). Mobilization within the first 4 h following anatomical lung resection is feasible and safe. Early mobilization provided pain relief after lung surgery and reduced the use of narcotic analgesics and cardiovascular complications. The article is the first study about walking in first hours after pulmonary lobectomy with thoracotomy in the thoracic surgery literature.
