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. 2017 Nov 15:10:2643-2648.
doi: 10.2147/JPR.S147691. eCollection 2017.

A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain

Hiroaki Kuroda  1 , Hitomi Mizuno  2 , Hitoshi Dejima  1 , Kiyoe Watanabe  2 , Tatsuya Yoshida  3 , Yumiko Naito  2 , Yukinori Sakao  1
Affiliations

A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain

Hiroaki Kuroda et al. J Pain Res. .

Abstract

Background: Thoracoscopic surgery (TS) has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aims of this study were to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS).

Materials and methods: A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on the NRS score.

Results: Of the 524 patients, mild pain was noted in 87% patients on the day of the operation and in 75.6% patients on ambulation. The mean NRS score was 1.83±1.49 on the day of the operation and 2.73±1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Multivariate analysis showed that high surgical stress significantly influenced pain scores. Reduction in pain with an NRS score of ≥1 was significant with the addition of pentazocine hydrochloride (p<0.01) and flurbiprofen (p<0.01). Interestingly, the addition of tramadol was borderline efficacious (p=0.05) in patients with an NRS score of >3 on ambulation.

Conclusion: A small number of patients have moderate-to-severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of ≥3.

Keywords: NRS; ambulation; postoperative pain; thoracoscopic surgery; tramadol.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Postoperative course of postoperative pain after TS in our hospital. Abbreviation: TS, thoracoscopic surgery.
Figure 2
Figure 2
Postoperative pain after TS. Notes: (A) Distribution of the maximum NRS score for pain on postoperative day (blue), upon ambulation (red), and on settling after medications (black). (B) ROC curve analyses for pain on postoperative day (blue), upon ambulation (red), and on settling after medications (black dotted). Arrows indicate the cutoff values. Abbreviations: TS, thoracoscopic surgery; NRS, numerical rating scale; ROC, receiver operating characteristic.
Figure 3
Figure 3
Number and efficacy of analgesic drugs for postoperative pain after TS. Notes: (A) Correlation between the number of analgesic drugs and the NRS score (r=0.451, p<0.01). (B) Comparison of the need for additional diclofenac, tramadol, pentazocine, pregabalin, and flurbiprofen to reduce pain with an NRS score of ≥1. (C) Comparison of the need for additional diclofenac, tramadol, pentazocine, pregabalin, and flurbiprofen to reduce pain with an NRS score of ≥3 upon ambulation dramatically. Abbreviations: TS, thoracoscopic surgery; NRS, numerical rating scale; In, including the applicable analgesic, Ex, excluding the applicable analgesic.
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