Painkiller administration after endoscopic submucosal dissection surgery: a retrospective real-world study

This study aimed to investigate the frequency of analgesic administration within 48 h after endoscopic submucosal dissection (ESD) or its derivative techniques across different segments of the digestive tract, as well as the timing of the initial analgesic administration.

This retrospective observational study was built upon previous research. The primary outcomes assessed were the time to initial analgesic administration postoperatively and the frequency of analgesic use within 48 h after ESD surgery. Additionally, factors influencing painkiller administration in ESD patients were analyzed.

Of the 2162 patients included in the study, 570 (26.36%) required postoperative analgesic medications. Most patients required their initial analgesic within 8 h following ESD, with the highest demand observed within 2 h. Multivariate Cox regression analysis indicated that intraoperative administration of ketorolac reduced the likelihood of analgesic administration within 2 h postoperatively (hazard ratio [HR] = 0.35, 95% confidence interval [CI]: 0.15-0.79, p = 0.012). The time to first analgesic administration did not differ significantly among patients with varying surgical sites (H = 2.043, p = 0.843) or surgical methods (H = 8.647, p = 0.071). Similarly, no significant difference was observed in the frequency of analgesic use within 48 h across different surgical sites (H = 3.817, p = 0.576). However, patients who underwent endoscopic submucosal excavation (ESE) surgery exhibited a lower frequency of analgesic use compared to those who underwent endoscopic full-thickness resection (EFR) surgery (p = 0.038).

A subset of patients undergoing ESD exhibited a need for analgesics within the initial 48-hour postoperative period. Clinicians should carefully assess patients' pain needs and implement appropriate pain relief measures to improve postoperative outcomes.

Chinese Clinical Trial Registry; ChiCTR2300072854.