Preoperative Patient Expectations of Postoperative Pain Are Associated with Moderate to Severe Acute Pain After VATS

Bayman, Emine O.; Parekh, Kalpaj R.; Keech, John; Larson, Nyle; Weg, Mark W. Vander; Brennan, Timothy J.

doi:10.1093/pm/pny096

Cited by 59 publications

(49 citation statements)

References 44 publications

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“…In this retrospective study of 1164 adult patients undergoing VATS, the prevalence of moderate-severe postoperative pain over 48 hours was 15.7%. This finding differs from the results obtained by Emine et al 6 , who reported a higher incidence of pain (59%). This is mainly owing to different patient characteristics, diverse types of surgery performed and distinct follow-up periods.…”

Section: Discussioncontrasting

confidence: 99%

“…Younger age is another consistent risk factor for moderate-severe pain following VATS, similar to a study including robotic-assisted thoracic surgery, VATS and open lobectomy 5 , but in contrast to a recent study reporting no age-related differences by limited sample size 6 . This finding could be explained by the fact that the old had higher pain threshold, more peripheral neuropathy and less scar with less stiffness, contributing to less pain.…”

Section: Discussionsupporting

confidence: 65%

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Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study

Sun

Liu

Chen

et al. 2020

Sci Rep

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Moderate-severe pain after surgical procedures is associated with decreased quality of life and increased costs. this study aimed to identify the incidence and predictive factors of moderate-severe postoperative pain within 48 hours following video-assisted thoracoscopic surgery (VATS) in a tertiary hospital. A retrospective cohort analysis was performed using medical records of adult patients who underwent VATS between January 2015 and December 2016. Logistic regression was performed to identify predictive factors for moderate-severe pain (visual analogue scale, VAS ≥ 4) within 24 hours and within 48 hours postoperatively. Of the 1164 participants, the incidence of moderate-severe pain was 12.7% within the first 24 hours and 15.6% within the first 48 hours after surgery. In multivariable analysis, the independent risk factors related to moderate-severe pain within 24 hours after surgery were younger age, increased body mass index, preoperative pain within 1 month and history of smoking. The risk factors for moderate-severe acute pain within 48 hours were almost the same, except that the number of chest tubes were also included. Moderate-severe postoperative pain following VATS is not rare, and presence of several risk factors deserves more aggressive pain management strategies perioperatively. Moderate-severe pain after surgical procedures is associated with prolonged hospital stays, readmissions, patient dissatisfaction, development of chronic pain, decreased quality of life and increased costs 1,2. It is widely accepted that better management of postoperative pain results in better patients' recovery. Video assisted thoracoscopic surgery (VATS), compared to conventional thoracotomy, is notable for less tissue trauma, improved postoperative respiratory function, and increased tolerability for the patients 3. Although potentially less postoperative pain was generally expected as one of the benefits of VATS 4 , many patients still suffer moderate to severe pain postoperatively 2,5-7. There are several reasons contributing to this unsatisfactory situation, one of them being that some patients may have certain risk factors for occurrence of more severe postoperative pain 8. Early identification of patients at risk may help to allow early application of effective treatment strategies to prevent unexpected suffering in these patients. Previously, several studies have focused on the predictors of postoperative pain and demographic, social psychological and clinical factors have been identified contributing to the development of severe postoperative pain 5,6,8,9. However, most of them are cohorts with mixed surgical procedures while VATS is not included. Moreover, various subtypes of VATS (uniportal, multiportal and robotic) exist currently, and the lack of guideline results in variation of analgesia regimens and effectiveness of analgesia in different medical centers 10. To date, the predictive factors of moderate-severe postoperative pain following VATS were not reported, which is important for individual-specific pa...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 65%

Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study

Sun

Liu

Chen

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…This result was consistent with previous reports. [3,33] Considering some patients were unwilling to take any extra analgesic drug even though they were unsatisfactory to the analgesia effect or their 9 sleep was disturbed by pain, we defined postoperative inadequate analgesia as not only patients with moderate to severe pain and required extra analgesic drug, but also patients with bad sleep quality and low satisfaction. This definition comprehensively comprises the real patients with inadequate analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…[29] The criteria for inclusion in the study were age from 18 to 70, ASA classification Ⅰ to Ⅲ, and voluntarily received patient-controlled intravenous (PCIA) treatment. The exclusion criteria included the following: (1) history of mental illness, chronic pain, and alcohol or drug abuse; (2) remarkably abnormal liver and/or kidney function (more than two times of the normal); (3) allergy to related opioid drugs; (4) women during pregnancy or lactation.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Single nucleotide polymorphisms associated with postoperative inadequate analgesia after single-port VATS in Chinese population

Xing

Bai

Sun

et al. 2020

Preprint

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Background: Postoperative inadequate analgesia following video-assisted thoracoscopic surgery (VATS) is a common and significant clinical problem. While genetic polymorphisms may play role in the variability of postoperative analgesia effect, few studies have evaluated the associations between genetic mutations and inadequate analgesia after single-port VATS. Methods: Twenty-eight single nucleotide polymorphisms (SNPs) among 18 selected genes involved in pain perception and modulation were genotyped in 198 Chinese patients undergoing single-port VATS. The primary outcome was the occurrence of inadequate analgesia in the first night and morning after surgery which was defined by a comprehensive postoperative evaluation. Multivariable logistic regression analyses were used to identify the association between genetic variations and postoperative inadequate analgesia. Results: The prevalence of postoperative inadequate analgesia was 45.5% in the present study. After controlling for age and education level, association with inadequate analgesia was observed in four SNPs among three genes encoding voltage-gated sodium channels. Patients with the minor allele of rs33985936 (SCN11A), rs6795970 (SCN10A), and 3312G>T (SCN9A) have an increased risk of suffering from inadequate analgesia. While the patients carrying the minor allele of rs11709492 (SCN11A) have lower risk experiencing inadequate analgesia. Conclusions: We identified that SNPs in SCN9A, SCN10A, and SCN11A play a role in the postoperative inadequate analgesia after single-port VATS. Although future larger and long-term follow up studies are warranted to confirm our findings, the results of the current study may be utilized as predictors for forecasting postoperative analgesic effect for patients receiving this type of surgery.Trial registration: This study was retrospectively registered in the ClinicalTrials.gov Registry (NCT03916120) on April 16, 2019.

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Lung cancer patients with positive programmed death‐ligand 1 expression endure graver postoperative pain

Wang

Zhou

Liu

et al. 2022

European Journal of Pain

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Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) is common in lung cancer patients, and it is unclear whether cancer itself participates in pain regulation. Programmed cell death ligand-1 (PD-L1) expressed by tumours may be analgesic. Our study aimed to detect the association between PD-L1 and acute postoperative pain. Methods:We reviewed patients who underwent VATS for lung cancer with tumour PD-L1 expression analysed in our centre from Jan 2017 to Jul 2020. They were divided into PD-L1 (−) group and PD-L1 (+) group and were further divided into four subgroups according to opioids for postoperative analgesia: sufentanil PD-L1 (−), sufentanil PD-L1 (+), oxycodone PD-L1 (−), and oxycodone PD-L1 (+). We compared the numeric rating scale (NRS) for the first three postoperative days at rest or cough between groups.Results: A total of 369 patients (167 in PD-L1 (−) vs. 202 in PD-L1 (+)) were included. On the first postoperative day, NRS at cough in the PD-L1 (+) patients were higher than those in the PD-L1 (−) patients (2.91 ± 1.07 vs. 2.66 ± 1.01, p = 0.018). On the third day, NRS at cough in PD-L1 (+) patients was higher (2.50 ± 1.02 vs. 2.26 ± 1.09, p = 0.043). For patients with oxycodone, NRS was higher in PD-L1 (+) than in PD-L1 (−) (p = 0.041) at cough after surgery. In contrast, those with sufentanil did not significantly differ in NRS between groups. Conclusions:Patients with PD-L1 (+) suffered graver pain in the early postoperative period after VATS for lung cancer compared with PD-L1 (−) on tumours. Analgesia with sufentanil seemed to overcome this effect better than oxycodone. Significance:We demonstrated that patients with positive programmed cell death ligand-1 (PD-L1) on tumours suffered graver pain in the early postoperative period after video-assisted thoracoscopic surgery for lung cancer and reacted differently with opioids. It might be beneficial to adjust analgesic protocols according to tumour PD-L1 expression for individualized postoperative pain management.

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Preoperative Patient Expectations of Postoperative Pain Are Associated with Moderate to Severe Acute Pain After VATS

Abstract: None of the preoperative psychosocial measures were associated with the moderate to severe acute pain after VATS. Average expected postoperative pain was the only measure associated with the development of moderate to severe acute pain after VATS.

Cited by 59 publications

References 44 publications

Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study

Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study

Single nucleotide polymorphisms associated with postoperative inadequate analgesia after single-port VATS in Chinese population

Lung cancer patients with positive programmed death‐ligand 1 expression endure graver postoperative pain

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