Negative pressure dressings and the impact on pain management on thoracic incisions in patients undergoing oesophagectomy: a pilot study

BackgroundPain control is recognised as a crucial post-operative measure for patients undergoing oesophagectomy with a thoracotomy incision for oesophageal cancer, where ineffective breathing due to pain is directly correlated with increased morbidity. The analgesic benefits of negative pressure wound therapy (NPWT) appear to be a relatively new and emerging finding. This pilot study aims to investigate the effects of NPWT on post-operative pain control and determine the feasibility of a larger trial.MethodTen consecutive patients undergoing oesophagectomy were prospectively enrolled to have a PREVENA Incision Management System placed over a closed thoracotomy wound. This dressing was changed at post-operative day 5 and removed after day 10. Post-operative morbidity was recorded and analgesia was prescribed by the Acute Pain Service who were blinded to the study aims. Analgesia requirements were recorded in oral morphine equivalents (OME) and compared to 30 patients that had previously undergone oesophagectomy via thoracotomy.ResultsOne patient was withdrawn from the study and there was no significant differences in patient demographics. The study group had less average daily analgesia requirements and reduced overall reported pain. Patients in the study group were less likely to develop pneumonia (44% and 57%) and less likely to require re-operation for complications of their surgery (0% and 10%).ConclusionThis pilot study shows reduced post-operative analgesia requirements and reduced morbidity when using NPWT over a closed thoracotomy wound, and affirms the feasibility of a future randomized control trial. Using negative pressure wound therapy dressing over a thoracotomy wound to improve post-operative pain control in patients undergoing oesophagectomy. Pilot study with results demonstrating a trend toward improved post-operative outcomes.image

Automated summary

Using negative pressure wound therapy (NPWT) over a closed thoracotomy wound for patients undergoing oesophagectomy can reduce post-operative analgesia requirements and morbidity rates.