Prediction of pleural adhesions by lung ultrasonography: An observational study

Abstract Objective Pleural adhesion makes the video-assisted thoracoscopic surgery (VATS) an arduous procedure, and can increase postoperative pain from accompanying adhesiolysis. We investigated the feasibility of lung ultrasonography for the prediction of pleural adhesion and postoperative pain in VATS. Design Blinded, prospective, observational study. Setting Tertiary teaching hospital, Seoul, South Korea. Participants Sixty patients (ASA I-III) scheduled to undergo VATS were assessed for eligibility. Following exclusions, 53 patients were enrolled and followed up. Interventions None. Measurements and Main results Patients were evaluated with lung ultrasonography during deep spontaneous respiration before induction of anesthesia, and surgeons confirmed the presence of pleural adhesion during the operation. The pain was evaluated using a numeric rating scale and by the amount of opioid consumption until 24 hours postoperatively. Lung ultrasonography showed acceptable predictability of pleural adhesion with the area under the receiver-operating characteristic curve (0.75; 95%CI, 0.67-0.83) and high specificity (0.97; 95%CI, 0.91-0.99), but low sensitivity (0.53; 95%CI, 0.38-0.68). The pain score was not different between sonographic adhesion (+) and (-) groups. However, the sonographic adhesion (+) group consumed more opioids until 24 hours postoperatively (fentanyl; 675 [558-805] μg vs. 420 [356-476] μg, p Conclusions Lung ultrasonography may help with planning postoperative pain management in VATS, however it was a better tool for ruling out pleural adhesion than detecting it.