Intraoperative Multimodal Approach for Pain After Thoracoscopic Pulmonary Resection

The optimal preemptive analgesia for thoracoscopic surgery remains unclear. We evaluated the utility of intraoperative intravenous analgesia on postoperative pain and the postoperative course in patients who underwent thoracoscopic lobectomy.

We retrospectively reviewed 228 consecutive patients who underwent single-lobe thoracoscopic lobectomy for malignant pulmonary tumors between October 2017 and December 2019. Instead of epidural anesthesia, intercostal nerve blocks were performed from the thoracic cavity. We assessed the differences in the clinical and perioperative parameters including postoperative pain among the following: (1) N group (nonintraoperative intravenous analgesia), (2) A group (1000 mg acetaminophen), and (3) AF group (1000 mg acetaminophen with 50 mg flurbiprofen axetil). The numerical rating scale (NRS) was used to assess pain.

Receiver operating characteristic curve analysis revealed that the optimal cutoff pain score for the additional analgesic within 12 h postsurgery was 3.5 (area under the curve = 0.771; sensitivity = 63%; specificity = 19.4%; 95% confidence interval [CI] = 0.703-0.839; p < 0.01). Less pain scores on the surgical day were related to the AF group (NRS; N, 3 ± 2.6; A, 3 ± 2.4; AF, 2 ± 1.9; p = 0.008, respectively). No pain or mild pain (NRS = 0-2) on the operative day was strongly associated with the AF group (N = 36.4%; A = 46.4%; AF = 70.5%; p = 0.005). None of the patients experienced complications associated with intraoperative intravenous analgesia.

The combined use of intravenous analgesics (acetaminophen and flurbiprofen axetil) and intercostal nerve blocks is a safe and feasible preemptive analgesic approach for thoracoscopic lobectomy.