Predictors of Acute Postoperative Pain in Cancer Patients Undergoing Elective Video-Assisted Thoracoscopic Surgery

Postoperative pain after video-assisted thoracoscopic surgery affects 43%-99% of patients and is associated with prolonged hospital stay. Pre- and intraoperative risk factors can help identify patients at higher risk of postoperative pain. This study aimed to assess if quantitative sensory testing, psychological factors, and patient characteristics can predict postoperative pain.

Patients undergoing elective video-assisted thoracoscopic surgery for confirmed or suspected lung cancer were included. Pain sensitivity was evaluated by quantitative sensory testing using cuff algometry, and psychological factors were assessed by the pain catastrophizing scale, and the hospital anxiety and depression scale. Clinical pain was assessed bidaily and summarized as time-weighted pain and opioid consumption was measured as cumulative dose, both within 48 h of surgery. Prediction models using pre- and intra-operative variables were established, and backward elimination was applied to identify independent predictors. Domain-specific models were constructed within five domains of predictors (i.e., quantitative sensory testing, psychological factors, demographics, perioperative, and tumour pathology). Subsequently, independent variables from the five domain-specific models were combined into a multifactorial model.

Domain-specific models explained between 5.1%-12.8% of variance except the demographics model which explained 39.5% of opioid consumption. The multifactorial models for pain intensity and opioid consumption explained 20.3% and 40.4%, respectively.

This study suggests that pre- and intra-operative factors contribute to the prediction of postoperative pain intensity and opioid consumption with varying precision. Demographic variables proved to be best and predicted 39.5% of postoperative opioid consumption. The multimodal models explained 20.3% of postoperative pain and 40.4% of postoperative opioid consumption.

This assessment and analysis presents factors that are associated with how patients who have undergone video-assisted thoracosopic surgery as a group report post-operative pain. Both patient-specific factors and perioperative management details appear to contribute.