Author(s): Xianfei Yan, Xiumei Chu, Nan Ge, Dong Wang, Yudong Han, Shixun Wang, Yang Li, Panpan Wang, Yongjie Wang
Background. Lobectomy by video-assisted thoracic surgery (VATS) has become a well-established and widespread therapeutic method for treating early lung cancer. However, VATS, especially VATS lobectomy, is still associated with moderate acute postoperative pain. The optimal strategy for postoperative analgesia after VATS lobectomy remains undetermined. Anesthesiologists and surgeons thus require an evidence-based VATS pain management approach. Methods. We retrospectively analyzed 352 patients who underwent VATS (either lobectomy or wedge resection). The patients were divided into four groups for comparative analysis of analgesic effects and safety: Group A, patient-controlled analgesia (PCA); Group B, PCA + flurbiprofen axetil (FA); Group C, PCA + FA + tramadol hydrochloride; and Group D, PCA + FA + a buprenorphine transdermal system (BTDS). Results. All 352 patients were included in the primary analysis. The analgesic effect in Group D was significantly better than that in the other three groups on postoperative days 2 and 3 (P = 0.035 and P = 0.001, respectively). Patients in Group D had better outcomes with respect to the postoperative day of chest tube removal (P = 0.000), volume of chest tube drainage (P = 0.024), and postoperative day of discharge (P = 0.000). However, the medical expense of hospitalization was not significantly different among the four groups (P = 0.809). Conclusions. Multimodal analgesia involving PCA + FA + BTDS provides effective analgesia; fewer analgesia-related complications; and a reduced patient economic burden, healthcare workload, and opioid requirement.
Buprenorphine Transdermal System, Multimodal Analgesia, Ain, stoperative, Video-Assisted Thoracic Surgery
- Kaseda, S., T. Aoki, N, and K. Shimizu, Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Annals of Thoracic Surgery, 2000. 70(5): p. 1644-1646.
- Lewis, R.J. and R.J. Caccavale, Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy (VATS(n)SSL). Seminars in Thoracic & Cardiovascular Surgery, 1998. 116(4): p. 332-339.
- Nagahiro, I., et al., Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Annals of Thoracic Surgery, 2001. 72(2): p. 362-365.
- Jr, M.K.R., W. Houck, and C.B. Fuller, Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Annals of Thoracic Surgery, 2006. 81(2): p. 421.
- Sugiura, H., et al., Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 1999. 9(6): p. 403.
- Steinthorsdottir, K.J., et al., Regional analgesia for video-assisted thoracic surgery: a systematic review. 2014. 45(6): p. 959.
- Khoshbin, E., et al., An audit of pain control pathways following video-assisted thoracoscopic surgery. Innovations, 2011. 6(4): p. 248-52.
- Joshi, G.P., et al., A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesthesia & Analgesia, 2008. 107(3): p. 1026-1040.
- Fibla, J.J., et al., The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial ☆. European Journal of Cardio-Thoracic Surgery, 2011. 40(4): p. 907-911.
- Kamiyoshihara, M., et al., Is epidural analgesia necessary after video-assisted thoracoscopic lobectomy? Asian Cardiovascular & Thoracic Annals, 2010. 18(5): p. 464-8.
- Nomori, H., et al., Preoperative Respiratory Muscle Training : Assessment in Thoracic Surgery Patients With Special Reference to Postoperative Pulmonary Complications. Chest, 1994. 105(6): p. 1782-1788.
- Brodsky, J.B. and E. Cohen, Video-assisted thoracic surgery. 2000. 13(1): p. 41-45.
- Landreneau, R.J., et al., Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Annals of Thoracic Surgery, 1993. 56(6): p. 1285-9.
- Bjerregaard, L.S., et al., High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial. Eur J Cardiothorac Surg, 2017.
- Scawn, N., et al., Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesthesia & Analgesia, 2001. 93(2): p. 260-264.
- Nalini, V. and R.L. Hines, Management of chronic pain in the elderly: focus on transdermal buprenorphine. Clinical Interventions in Aging, 2008. 3(3): p. 421.
- Pergolizzi, J., et al., Current knowledge of buprenorphine and its unique pharmacological profile. Pain Practice, 2010. 10(5): p. 428-450.
- Bortsov, Andrey V., et al., μ-Opioid Receptor Gene A118G Polymorphism Predicts Survival in Patients with Breast Cancer. Anesthesiology, 2012. 116(4): p. 896.
- Wang, S., et al., Polymorphism of A118G in μ-opioid receptor gene is associated with risk of esophageal squamous cell carcinoma in a Chinese population. International Journal of Clinical Oncology, 2013. 18(4): p. 666-669.
- Lennon, F.E., et al., The Mu Opioid Receptor Promotes Opioid and Growth Factor-Induced Proliferation, Migration and Epithelial Mesenchymal Transition (EMT) in Human Lung Cancer. Plos One, 2014. 9(3): p. e91577.
- Lennnon, F.E., et al., Abstract 2232: Overexpression of the mu opioid receptor in human non-small cell lung cancer promotes Akt and mTOR activation, tumor growth and metastasis. Cancer Research, 2012. 72: p. 2232-2232.
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