Should a chest drain be left in post thoracoscopic bullectomy and pleurectomy in children?

Chest drains are usually placed following thoracoscopic surgery but they cause significant post-operative pain. Some data suggests they may not be required but there is little evidence in the paediatric population. We aimed to assess whether it is safe to perform thoracoscopic bullectomy and pleurectomy (BP), for Spontaneous Pneumothorax (SP) without a chest drain and the impact on length of stay and opiate usage.

A retrospective case notes review of all patients having a thoracoscopic BP between March 2018 to March 2022 in a single tertiary unit was performed. Data was gathered on demographics, length of stay, opiate use (oramorph in mg/kg, PCA length and intravenous morphine dose in mg/kg) and complications. A comparison was made between those with and without a chest drain using a Mann Whitney U.

Fifteen patients were identified and there were 19 BPs during the study period. Eleven had a chest drain and 8 did not. Those that had a chest drain had a significantly higher intravenous morphine use (1.635mg/kg vs 0.34 mg/kg) and length of PCA (46.5 vs 13-h). Those without a chest drain were discharged significantly quicker (1 vs 2 days).

In line with recent literature, in most circumstances it is safe to perform a thoracoscopic BP without a chest drain and it is likely to reduce length of stay and opiate use.