Comparison between the effects of epidural and intravenous patient-controlled analgesia on postoperative disability-free survival in patients undergoing thoracic and abdominal surgery: A post hoc analysis

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2024-03-21 DOI:10.1002/ejp.2266

S. Hirai, M. Ida, Y. Naito, M. Kawaguchi

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Abstract

Background

Thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) are widely used to mitigate immediate postoperative pain; however, their effects on long-term disability-free survival are poorly documented. This study aimed to compare the effects of postoperative TEA and IV-PCA on disability-free survival in patients who underwent thoracic or abdominal surgery.

Methods

This post hoc analysis of a prospective observational study included 845 inpatients aged ≥55 years that underwent elective thoracic and abdominal surgery between 1 April 2016 and 28 December 2018 in a tertiary care hospital. Inverse probability of treatment weighted (IPTW) using stabilized inverse propensity scores was adopted to minimize bias. The primary outcome in this study was disability-free survival, defined as survival with a 12-item World Health Organization Disability Assessment Schedule 2.0 score of <16%, assessed at 3 months and 1 year after surgery.

Results

The final analysis included 601 patients who received TEA and 244 who received IV-PCA. After IPTW, the weighted incidence of disability-free survival at 3 months and 1 year was 60.5% and 61.4% in the TEA group and 78.3% and 66.2% in the IV-PCA group, respectively. The adjusted OR for disability-free survival at 3 months and 1 year was 0.84 (95% confidence interval [CI]: 0.50–1.39) and 1.21 (95% CI: 0.72–2.05), respectively, for the TEA group.

Conclusion

No significant differences were observed in the disability-free survival at 3 months and 1 year after elective thoracic and abdominal surgery in patients aged ≥55 years who received TEA or IV-PCA.

Significance statement

This study is the first in our setting to document the long-term effects of patient-controlled analgesia. In a post hoc analysis of our prospective cohort study, we show that although differences in chronic postsurgical pain exist at 3 months post-surgery, disability-free survival rates at 1 year do not differ irrespective of the choice of patient-controlled analgesia. The findings of this study highlight the need for shared decision-making between clinicians and patients.

查看原文本刊更多论文

比较硬膜外镇痛和静脉注射患者自控镇痛对胸腹手术患者术后无残疾存活率的影响：事后分析。

背景：胸腔硬膜外镇痛（TEA）和静脉患者自控镇痛（IV-PCA）被广泛用于减轻术后即刻疼痛；然而，它们对长期无残疾生存率的影响却鲜有记载。本研究旨在比较术后 TEA 和 IV-PCA 对胸腔或腹腔手术患者无残疾存活率的影响：这项前瞻性观察研究的事后分析纳入了2016年4月1日至2018年12月28日期间在一家三甲医院接受择期胸腹手术的845名年龄≥55岁的住院患者。采用稳定反倾向评分的反向治疗概率加权（IPTW），以尽量减少偏倚。本研究的主要结果是无残疾存活率，即世界卫生组织残疾评估表2.0的12项评分结果为无残疾存活率：最终分析包括 601 名接受 TEA 的患者和 244 名接受 IV-PCA 的患者。IPTW后，TEA组3个月和1年的无残疾生存加权发生率分别为60.5%和61.4%，IV-PCA组分别为78.3%和66.2%。TEA组3个月和1年后无残疾生存率的调整OR值分别为0.84（95%置信区间[CI]：0.50-1.39）和1.21（95% CI：0.72-2.05）：结论：年龄≥55岁的患者在接受TEA或IV-PCA的择期胸腹部手术后3个月和1年的无残疾生存率无明显差异：本研究是我们首次记录患者自控镇痛的长期效果。在对我们的前瞻性队列研究进行的一项事后分析中，我们发现虽然术后 3 个月的慢性术后疼痛存在差异，但无论选择哪种患者自控镇痛，1 年后的无残疾存活率并无不同。这项研究结果强调了临床医生和患者共同决策的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.