How painful is lung cancer surgery?
How painful is lung cancer surgery?
An important consideration (usually in the back of the mind) of most who are offered surgery as part of a treatment option for lung cancer is exactly how much pain will be experienced by the operation itself. The question is simple but the answer can be complex to answer.
In short, it depends on how much effort your surgical team takes to ensure that your pain is managed, and how the surgeon enters your chest (keyhole or open thoracotomy). At one end of the spectrum is an epidural catheter which is a thin tube positioned in your spinal canal infusing anesthetics that produces the least pain (with risks such as low blood pressure, retention of urine and spinal infection) to the other end of the spectrum which is simply pain killers taken by mouth or into your veins.
In the UK and increasingly across the world, surgeons are numbing the nerves (intercostal blocks) as part of the routine care and infusing anesthetics into the lining of the chest so the nerves are continuously bathed in anesthetic (paravertebral block).
In a 500-patient study I led called VIOLET, we monitored the daily pain that patients experienced after lung cancer surgery with a combination of intercostal, paravertebral blocks, oral and intravenous pain killers and asked them to rate their pain on a score of 0-10. On the first day, the pain score (on average) was 4 out of 10 By the second day, those that had keyhole surgery had an average score of 3 out of 10 (and those with open surgery had a score of 4 of of 10).
The pain score on its own is difficult to provide an accurate assessment of true pain, as it is modified by the amount of pain killers that you receive. For example, if a person with a deep cut is given nothing and reports a pain score of 2, it is not comparable to another person with a deep cut given a lot of morphine and reports a pain score of 2. In the VIOLET study, we found pain scores of patients receiving keyhole was slightly less than open (thoracotomy), and the amount of pain killers used to achieve the same score was approximately 10% less - implying a less painful incision and surgical technique.
What is reassuring, is that for all our study participants in VIOLET on the first day of surgery (which is usually the most painful day) 25% had pain scores of 2 or less and 75% with pain score of 5 or less. For people this is usually an acceptable level of pain.
The author Professor Eric Lim was the Chief Investigator of VIOLET, a multi-center UK wide clinical trial of keyhole versus open surgery for lung cancer studying a wide range of clinical outcomes during and after lung cancer surgery.