Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study

Abstract

Purpose

This study aimed to investigate whether preoperative computerized tomography-guided hookwire localization-associated pain could affect acute and chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS).

Methods

We enrolled 161 adult patients who underwent elective VATS; sixty-nine patients experienced hookwire localization (Group A) and 69 did not (Group B). Group A was further subdivided into the multiple localization group (n=35, Group A_multiple) and the single localization group (n=34, Group A_single) according to the number of hookwires. The numerical rating scale (NRS) was used preoperatively, during recovery at the post-anesthesia care unit (PACU), and the first two days, 3 and 6 months postoperatively. Furthermore, multivariate regression analysis was used to identify the risk factors associated with CPSP. The postoperative adverse events, length of hospital stay, and satisfaction in pain management were also recorded.

Results

The incidence and severity of acute postoperative pain were similar between Group A and Group B (p > 0.05). The incidence (56.5% vs 30.4%, p = 0.002) and the NRS scores (2.0 [2.0–3.0] vs 1.0 [1.0–2.0], p = 0.011) for CPSP were significantly higher in Group A than in Group B at 3 months postoperatively. On subgroup analysis, compared with Group A_single, the intensity of CPSP (2.0 [2.0–3.0] vs 2.0 [1.0–2.0], p = 0.005) in Group A_multiple was slightly higher at 3 months postoperatively. Conversely, the CPSP incidence (60.0% vs 29.4%, p = 0.011) was significantly higher at 6 months postoperatively in Group A_multiple. The multivariate regression analysis further validated hookwire localization as a risk factor for CPSP (odds ratio: 6.199, 95% confidence interval 2.049–18.749, p = 0.001). Patient satisfaction relating to pain management at 3 months postoperatively was lower in Group A (p = 0.034).

Conclusion

The preoperative pain stress of hookwire localization increased the incidence and intensity of CPSP rather than acute pain at 3 months postoperatively, especially in patients with multiple hookwires.

Keywords:

• chronic postsurgical pain
• postoperative acute pain
• hookwire localization
• video-assisted thoracoscopic surgery
• lung cancer

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Files can be emailed to anyone that concerned.

Ethics Approval and Informed Consent

This study was approved by the Ethics Committee of the Fudan University Shanghai Cancer Center, with the ethics number:2107238-15. The trial was registered after patient enrollment at clinicaltrials.gov (NCT05478460). Patients provided written consent. All methods were carried out in accordance with Declaration of Helsinki.

Acknowledgments

This study was supported by Shanghai Municipal Natural Science Foundation (to Jun Zhang, No.22Y11904200). Thanks are also given to surgeons in Department of thoracic surgery for their help on data collection.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was funded by a grant from the Shanghai Science and Technology Committee (No.20Y11906200). The funder was not involved in the design, conduct, or publication of this work.