Exploring the impact of perioperative analgesia on postoperative chronic analgesic prescriptions in patients with lung cancer undergoing minimally invasive thoracic surgery: A retrospective observational study

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2024-12-27 DOI:10.1002/ejp.4774

Shizuha Yabuki, Yu Kaiho, Kunio Tarasawa, Saori Ikumi, Yudai Iwasaki, Takahiro Imaizumi, Kenji Fujimori, Kiyohide Fushimi, Masanori Yamauchi

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Abstract

Background

Lung cancer surgery is associated with a high incidence of chronic postsurgical pain (CPSP), which necessitates long-term analgesic prescriptions. However, while essential for managing pain, these have shown various adverse effects. Current guidelines recommend using peripheral nerve blocks over epidural anaesthesia for perioperative analgesia in minimally invasive thoracic surgery (MITS). However, the impact of perioperative analgesia on chronic analgesic prescriptions remains unclear. Therefore, this study investigated chronic analgesic prescription patterns following MITS in patients with lung cancer who received either perioperative epidural anaesthesia or nerve block.

Methods

We conducted a retrospective cohort study using data from the Japanese Diagnosis Procedure Combination database. Data were extracted from patients with primary lung cancer who underwent MITS between April 2018 and March 2022. Patients were divided into two groups based on the perioperative analgesia they received: the epidural anaesthesia group and the nerve block group. We compared the proportion of analgesic prescriptions 3–6 months postoperatively between both groups using multivariable logistic regression analysis. Inverse probability of treatment weighting was used to balance the covariates between the two groups.

Results

Among the 38,719 eligible patients, 4513 (11.6%) were prescribed postoperative analgesics. We found no significant difference in the proportion of analgesic prescriptions between the epidural anaesthesia and nerve block groups (odds ratio, 1.00; 95% confidence interval, 0.99–1.01).

Conclusions

This nationwide retrospective study suggests that the choice between perioperative epidural anaesthesia or nerve block in patients with lung cancer undergoing MITS does not influence the proportion of postoperative chronic analgesic prescriptions.

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探讨围手术期镇痛对肺癌微创胸外科患者术后慢性镇痛处方的影响：一项回顾性观察研究。

背景：肺癌手术与慢性术后疼痛（CPSP）的高发相关，这需要长期的镇痛处方。然而，尽管这些对控制疼痛至关重要，但它们也显示出各种不利影响。目前的指南推荐在微创胸外科手术（MITS）的围术期镇痛中使用周围神经阻滞而不是硬膜外麻醉。然而，围手术期镇痛对慢性镇痛处方的影响尚不清楚。因此，本研究调查了接受围手术期硬膜外麻醉或神经阻滞的肺癌患者在MITS后的慢性镇痛处方模式。方法：我们使用来自日本诊断程序组合数据库的数据进行回顾性队列研究。数据来自2018年4月至2022年3月期间接受MITS治疗的原发性肺癌患者。根据围手术期镇痛情况将患者分为硬膜外麻醉组和神经阻滞组。采用多变量logistic回归分析比较两组患者术后3-6个月使用镇痛药的比例。采用治疗加权的逆概率来平衡两组间的协变量。结果：在38,719例符合条件的患者中，4513例（11.6%）使用了术后镇痛药。我们发现硬膜外麻醉组和神经阻滞组的镇痛药处方比例无显著差异(优势比为1.00；95%可信区间为0.99-1.01)。结论：这项全国范围内的回顾性研究表明，选择围手术期硬膜外麻醉还是神经阻滞对肺癌行MITS患者术后慢性镇痛处方的比例没有影响。

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.