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Eur J Cardiothorac Surg 2004;25:1054-1058
© 2004 Elsevier Science NL

Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax

Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China

Received 27 November 2003; received in revised form 11 February 2004; accepted 16 February 2004.

^* Corresponding author. Tel.: +852-2632-2629; fax: +852-2647-8273
e-mail: yimap{at}cuhk.edu.hk

Objective: Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or complicated primary spontaneous pneumothorax (PSP). However, a proportion of patients still complains of chronic pain or discomfort after VATS pleurodesis. We aimed to investigate if paresthesia is a distinct component of the post-operative discomfort in patients receiving VATS for PSP. Methods: Telephone interviews were conducted with 52 patients who had received VATS pleurodesis for PSP in our institute during a defined 24 month period. A standardized questionnaire was used to identify paresthetic discomforts which the patients themselves could distinguish from their wound pain. Responses were obtained from 51 patients (42 male, 9 female) with a mean age of 24.1 years (range 14–63 years), giving a response rate of 98.0%. Results: With a median observation time of 19 months (range 2–24 months), 27 patients (52.9%) reported experiencing paresthesia as a post-operative complication distinct from their wound pain. The most commonly described characteristics of the paresthesia were ‘pins and needles’ (37.0%), ‘numbness’ (25.9%) or a sensation of abnormal ‘swelling’ in the chest wall (11.1%). Although only two of the affected patients (7.4%) described the paresthesia as ‘severe’, consequent functional disturbances in daily life were noted by seven patients (25.9%), and 11 patients (40.7%) actively sought medical or alternative, holistic therapies to relieve the paresthesia. Eight (21.0%) of the 38 patients followed-up for over 12 months after surgery still experienced the paresthesia. Conclusions: Although it should not detract from the proven advantages of VATS, paresthesia in the chest wall represents a distinct but previously overlooked post-VATS complication. It is a potential source of significant post-operative morbidity, and may run a chronic course in some patients. Further study is warranted to elucidate its mechanisms and optimum management.

Key Words: Chest wall • Complications of surgery • Neurologic injury • Pneumothorax • Video-assisted thoracic surgery

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