Perioperative Analgesic Effect And Related Factors Of Postoperative Chronic Pain In Thoracic Surgery

Objective: With the deepening of the ERAS concept,the postoperative analgesia in traditional thoracic surgery is challenged.There is no uniform analgesia for patients undergoing video-assisted thoracoscopic lobectomy.There is also no prospective clinical trial for postoperative Related factors for the influencing factors of chronic pain.In combination with clinical needs,we explored the analgesic program suitable for our department after VATS lobectomy and explored the related factors that affect the occurrence of postoperative chronic pain.Methods: According to colleagues from the Department of Statistics,Qingdao University,the postoperative data of 150 patients were analyzed.The strict enrollment and exclusion criteria were followed by VATS lobectomy + lymph node dissection for early lung cancer from the same medical group.150 patients were randomly assigned to the A,B,and C groups,respectively,and received different analgesic regimens.Observed the postoperative VAS pain score,anesthesia-related side effects,analgesic medication,continuous chest drainage time,postoperative hospital stay,etc.,and regular follow-up of patients included in the trial analysis(mean follow-up time ? 5 months),and The followup data was analyzed.Results: After rigorous screening,150 patients enrolled in the trial were randomly divided into three groups: A,B,and C.The three groups received different postoperative analgesia programs,and collected relevant clinical data and statistically processed them.The visual pain simulation scores(VAS scores)of the three groups were similar at 6 hours after surgery,and there was no statistical difference(P=0.839).On the first day after surgery,the average VAS scores of group A patients were lower,and there was significant difference between group A and the other two groups.(P=0.038);on the second day after surgery,in the three groups of patients who underwent VATS lobectomy,although the VAS scores were lower in group A,there was no significant difference between the three groups(P=0.605);After three days,the pain scores of group C were significantly higher than those of the other two groups(P=0.007;P=0.026).Although the mean VAS score of group A was lower than that of group B,there was no significant difference between the two groups(P=0.637).Anesthesia-related side effects were observed in approximately 74% of patients in group A,which was significantly higher than group B(56%)and group C(48%)(P=0.025).Approximately 30% of patients in Group A had acute pain associated with analgesia/other causes of other analgesic medications,and the incidence of medications required was significantly lower than the other two groups(P=0.031).There was a statistically significant difference in the duration of continuous thoracic drainage between the three groups.The continuous chest drainage time required in group A was significantly lower than that in group B and C(P=0.007;P=0.000),and between group B and group C.There was no statistically significant difference between patients.The average hospital stay in group A was also significantly lower than that in group B and C(P=0.000).According to the telephone follow-up results,the incidence of chronic pain after thoracic surgery in our hospital was 24%.Risk factors included age below 60 years(OR: 2.147,95% CI: 1.002-4.598),female(OR: 3.755,95)%CI: 1.577-8.938),postoperative analgesia lacked PCA(OR: 2.196,95% CI: 1.017-4.740),postoperative analgesia lacked buprenorphine transdermal patch(OR: 3.500,95% CI: 1.607-7.632),chest tube drainage time is extended(? 4 days)(OR: 2.657,95% CI: 1.154-6.116).Conclusion: The analgesic regimen of patients in group A(PCIA + buprenorphine transdermal patch + flurbiprofen axetil 50 mg Bid)was the most ideal for postoperative analgesia,but at the same time,the incidence of anesthesia-related side effects was also The highest,followed by continuous chest drainage time and postoperative hospital stay,we found that because of group A patients with better postoperative analgesia,postoperative cough,postoperative pneumonia incidence is lower,chest drainage is better Continuous chest drainage time is shorter than the other two groups,and the postoperative hospital stay is relatively short.Comprehensive evaluation of three different analgesic programs,we recommend clinical use of group A analgesic program,can achieve ideal analgesia The effect can shorten the postoperative hospital stay,reduce the economic pressure of patients,and allow the limited use of medical resources.Chronic pain is a common complication of thoracic surgery and can significantly affect the patient's daily life.Our study shows that about a quarter of patients undergoing thoracic surgery experience chronic chest pain with ongoing chest surgery.Several predictive risk factors were found in our study,such as age <60 years,female,continuous drainage time of the chest ? 4 days,and insufficient analgesic effect.Further research is needed to investigate the impact of minimizing risk factors on the incidence of CPSP,particularly in reducing the multifaceted approach to chest tube drainage.