Background

Semi-rigid and large bore (≥ Fr 24) polyvinyl chloride (PVC) drains are routinely used for the evacuation of fluid and air from the pleural space following video-assisted thoracoscopic surgery (VATS) lung resections. The rigidity and caliber of these drains are widely recognized as significant contributors to postoperative pain. Inadequate pain management can thereby compromise respiratory efficiency, coughing, and patient mobility, potentially precipitating respiratory complications like atelectasis and pneumonia (1-7). In VATS, postoperative pain has been commonly assessed through a combination of methods, including pain scales, analgesic consumption analysis, and functional evaluation tests (5,8-12).

Rationale and knowledge gap

In recent years, significant efforts have been made to minimize drain-related postoperative pain by modifying and improving the methods of chest drainage. Since one or two large bore drains (≥ Fr 24) are still commonly used to ensure effective drainage of air leaks, improvements have also been directed towards the materials used for the drains (1-4,7).

Hence, there has been growing adoption of softer silicone (SIL) drains, purportedly offering reduced patient discomfort without compromising drainage efficacy compared to standard PVC drains. Previous studies have demonstrated the efficacy of SIL drains in fluid management and suggested potential pain reduction following diverse chest procedures, encompassing VATS and open surgeries (1-4,13,14). However, the benefit of SIL drains in reducing postoperative pain after VATS anatomical lung resections has not yet been clearly demonstrated, and postoperative pain remains a significant concern.

Objective

The objective of our prospective randomized study was to evaluate the impact of coaxial SIL drains on postoperative pain, drainage efficacy, short-term treatment outcome, and costs following VATS lobectomy, in comparison to standard PVC drains. Authors hypothesized that patients receiving a coaxial SIL drain would require less analgesia and demonstrate greater respiratory muscle strength. Furthermore, authors anticipated that drainage efficacy and short-term treatment outcome would be comparable between the two groups.