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Independent Predictors for Higher Postoperative Pain Intensity During Recovery After Open Thoracic Surgery: A
Sandra Kampe1,2, Martin Wendland1, Stefan Welter3
1Departments of Anesthesiology and Pain Medicine.
Pain Medicine (Malden, Mass.)
|April 11, 2018
Summary
Epidural analgesia significantly reduced postoperative pain after thoracic surgery compared to oral opioids. Key risk factors for increased pain include lack of epidural use, female gender, and prior opioid or antidepressant use.
Area of Science:
- Thoracic Surgery
- Pain Management
- Anesthesiology
Background:
- Postoperative pain following thoracic surgery is a significant clinical challenge.
- Optimizing pain management strategies is crucial for patient recovery and outcomes.
Purpose of the Study:
- To compare the efficacy of two standard pain regimens: oral opioid analgesia versus epidural analgesia bridged to systemic opioids.
- To identify independent predictors of higher pain intensity after thoracic surgery.
Main Methods:
- Retrospective observational study of 621 patients undergoing open thoracotomy.
- Analysis of medical history, discharge letters, and anesthetic/pain protocols.
- Multivariate logistic regression using stepwise backward elimination to identify risk factors.
Main Results:
- The epidural analgesia plus opioid group (EDA + O) showed significantly lower pain scores at rest and on coughing on postoperative days (PODs) 1-4 compared to the Opioid Group.
- Independent risk factors for higher pain intensity included: no epidural analgesia, preexisting pain disease, preoperative opioid therapy, and antidepressant medication.
- Male gender and younger age were associated with lower pain on coughing; preexisting musculoskeletal disease was linked to lower pain at rest on later PODs.
Conclusions:
- Lack of postoperative epidural analgesia, female gender, preexisting opioid pain therapy, and chronic pain are strong predictors of higher pain intensity after thoracotomy.
- Antidepressant medication is an independent risk factor for pain at rest and on coughing throughout the postoperative period.
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