Evaluating the association of preoperative parecoxib with acute pain trajectories after video-assisted thoracoscopic surgery: a single-centre cohort study in Taiwan

ObjectiveThe efficacy of parecoxib as pre-emptive analgesia still remains controversial. This study aimed to investigate how pre-emptive analgesia with parecoxib affected postoperative pain trajectories over time in patients undergoing thoracic surgery.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsWe collected 515 patients undergoing video-assisted thoracoscopic surgery at a tertiary medical centre between September 2016 and August 2017.InterventionsPre-emptive parecoxib before surgery.Primary and secondary outcome measuresDaily numeric rating pain scores in the first postoperative week.ResultsA total of 196 (38.1%) of the recruited patients received parecoxib preoperatively. The latent curve analysis revealed that woman, higher body weight and postoperative use of parecoxib were associated with increased baseline level of pain scores over time (p=0.035, 0.005 and 0.048, respectively) but epidural analgesia and preoperative use of parecoxib were inclined to decrease it (both p<0.001). Regarding the decreasing trends of changes in daily pain scores, older age and epidural analgesia tended to steepen the slope (p=0.014 and <0.001, respectively). Preoperative use of parecoxib were also related to decreased frequency of rescue morphine medication (HR=0.4; 95% CI 0.25 to 0.65).ConclusionsPre-emptive analgesia with parecoxib was associated with decreased baseline pain scores but had no connection with pain decreasing trends over time. Latent curve analysis provided insights into the dynamic relationships among the analgesic modalities, patient characteristics and postoperative pain trajectories.

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Dynamic analysis of variations in postoperative pain trajectories over time in patients receiving epidural analgesia using latent curve models

Journal of the Chinese Medical Association ◽

10.1097/jcma.0000000000000200 ◽

2020 ◽

Vol 83 (1) ◽

pp. 89-94 ◽

Cited By ~ 1

Author(s):

Ming-Ying Lee ◽

Wen-Kuei Chang ◽

Hsiang-Ling Wu ◽

Shih-Pin Lin ◽

Mei-Yung Tsou ◽

...

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Dynamic Analysis ◽

Latent Curve ◽

Latent Curve Models ◽

Pain Trajectories ◽

Over Time

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Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01590-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jian Wei Tan ◽

Jameelah Sheik Mohamed ◽

John Kit Chung Tam

Keyword(s):

Postoperative Pain ◽

Length Of Stay ◽

Urinary Retention ◽

Feasibility Study ◽

Thoracoscopic Surgery ◽

Early Recovery ◽

Rescue Analgesia ◽

Video Assisted ◽

Pain Scores ◽

Video Assisted Thoracoscopic Surgery

Abstract Background Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

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Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2019-031936 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031936 ◽

Cited By ~ 4

Author(s):

Ying-Hsuan Tai ◽

Hsiang-Ling Wu ◽

Shih-Pin Lin ◽

Mei-Yung Tsou ◽

Kuang-Yi Chang

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Abdominal Surgery ◽

Influential Factors ◽

Secondary Outcome ◽

Patient Controlled Analgesia ◽

Latent Curve ◽

Latent Curve Models ◽

Pain Trajectories ◽

Complex Relationships

ObjectivesWe aimed to investigate the factors associated with variations in postoperative pain trajectories over time in patients using intravenous patient-controlled analgesia (IV-PCA) for postoperative pain.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsPatients receiving IV-PCA after surgery.Primary and secondary outcome measuresPrimary outcome was the postoperative pain scores.ResultsA total of 3376 patients and 20 838 pain score observations were analysed using latent curve models. Female and longer anaesthesia time increased the baseline level of pain (p=0.004 and 0.003, respectively), but abdominal surgery and body weight decreased it (both p<0.001). Regarding the trend of pain resolution, lower abdominal surgery steepened the slope (p<0.001); older age, American Society of Anesthesiologists (ASA) class ≥3 and longer anaesthesia time tended to flatten the slope (p<0.001, =0.019 and <0.001, respectively). PCA settings did not affect the variations in postoperative pain trajectories.ConclusionsPatient demographics, ASA class, anaesthesia time and surgical sites worked together to affect postoperative pain trajectories in patients receiving IV-PCA. Latent curve models provided valuable information about the dynamic and complex relationships between the pain trajectories and their influential factors.

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Group-based trajectory analysis of postoperative pain in epidural analgesia for video-assisted thoracoscopic surgery and risk factors of rebound pain

Journal of the Chinese Medical Association ◽

10.1097/jcma.0000000000000647 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Wen-Kuei Chang ◽

Yi-Shiuan Li ◽

Hsiang-Ling Wu ◽

Ying-Hsuan Tai ◽

Shih-Pin Lin ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Pain ◽

Epidural Analgesia ◽

Trajectory Analysis ◽

Thoracoscopic Surgery ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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A Comparison of Subxiphoid and Intercostal Wound Pain in the Same Patients Following Thoracic Surgery

10.21203/rs.3.rs-846594/v1 ◽

2021 ◽

Author(s):

Yu-Wei Liu ◽

Shah-Hwa Chou ◽

Andre Chou ◽

Chieh-Ni Kao ◽

Hung-Hsing Chiang ◽

...

Keyword(s):

Postoperative Pain ◽

Subjective Experience ◽

Rating Scale ◽

Thoracoscopic Surgery ◽

Pain Scores ◽

Lower Pain ◽

Postoperative Time ◽

Wound Pain ◽

Pain Rating Scale ◽

Video Assisted Thoracoscopic Surgery

Abstract Background: There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual's subjective experience and therefore difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Methods: Data from 26 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to April 2020. All patients received same length subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180.Results: Bilateral uniportal VATS was performed in 11 patients and unilateral multiportal VATS in 15 patients. In the unilateral VATS group, there were no significant differences in pain reported for subxiphoid and intercostal incisions. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher mean pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively) but lower pain scores on POD-90 (p = 0.03). Conclusions: In the bilateral VATS group, higher late (3 and 6 months) postoperative pain was associated with intercostal incisions as have been reported by previous studies. Interestingly, subxiphoid incisions were found to have higher early (Day 1, 2, and Discharge) postoperative pain than intercostal incisions. More research is needed to better understand the cause of pain in a surgical area previously not thought to be prone to pain.

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An Audit of Pain Control Pathways following Video-Assisted Thoracoscopic Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31822b2cc1 ◽

2011 ◽

Vol 6 (4) ◽

pp. 248-252 ◽

Cited By ~ 5

Author(s):

Espeed Khoshbin ◽

Ali N. Al-Jilaihawi ◽

Nicholas B. Scott ◽

Dhruva Prakash ◽

Alan J. B. Kirk

Keyword(s):

Pain Management ◽

Pain Relief ◽

Visual Analog Scale ◽

Severe Pain ◽

Thoracoscopic Surgery ◽

Analog Scale ◽

Pain Scores ◽

Audit Commission ◽

Video Assisted Thoracoscopic Surgery ◽

Daily Pain

Objective To compare different modes of pain management following video-assisted thoracoscopic surgery (VATS) to our national standard. Methods This is an audit based on patient's experiences. One hundred consecutive patients who underwent VATS with or without pleurodesis were managed by one of the following pain relief pathways: (A) thoracic paravertebral block + morphine patient-controlled analgesia (PCA), (B) percutaneous thoracic paravertebral catheter +/– morphine PCA, (C) thoracic epidural +/– morphine PCA, (D) morphine PCA alone, and (E) intravenous or subcutaneous morphine as required. Pain score was documented up to four times per day for each patient. The incidence of severe pain was defined as visual analog scale ≥7. The results were compared with the standard set by the audit commission for postoperative pain relief in the UK. The mean daily pain scores were calculated retrospectively for all patients. Results There were no statistically significant differences in mean daily pain scores irrespective of having a pleurodesis. The percentage of patients experiencing severe pain was 34% [mean visual analog scale = 8 (standard deviation = 1.0)]. This was almost seven times the standard. Among these pathways, B had the least percentage incidence of severe pain (16.7%) followed by A (25.0%) D (33.3%), C (35.7%), and E (52.4%). Conclusions We are not compliant with the standards set by the audit commission. Pain management in theater recovery needs to be targeted. In the light of these results, we recommend the use of percutaneous thoracic paravertebral catheter +/– morphine PCA for postoperative VATS pain relief.

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