Influencing Factors Of Chronic Post-Surgical Pain After VATS Lobectomy In Early Non-Small Cell Lung Cancer

BackgroundPrimary bronchial lung cancer is referred to as lung cancer,which originates from alveolar grade bronchial mucosa and alveoli.As one of the tumors with the highest morbidity and mortality in the world and China,lung cancer is a serious threat to human health.According to the Chinese Medical Association guidelines for clinical diagnosis and treatment of lung cancer(Edition 2018),the optimal solution for local treatment of early non-small cell lung cancer is still radical surgical resection and anatomical lobectomy is still its standard operation(recommended for type first evidence).Postoperative pain is a common postoperative complication of chest surgery.According to the International Association for the Study of Pain,postoperative pain is divided into acute postoperative pain and chronic post-surgical pain(CPSP).Acute postoperative pain refers to pain occurring 24-72 hours after surgery,and chronic post-surgical pain refers to secondary pain.Pain after acute surgery,and the time lasts for more than 2 months.With the development of video-assisted thoracoscopy surgey technology,it has a series of advantages such as good surgical field visualization and minimal trauma.Today,a large number of clinical studies have shown that,in terms of reducing the incidence of postoperative acute pain and its pain score or chronic pain and its pain score after surgery,video-assisted thoracoscopic lobectomy has obvious advantages over traditional thoracotomy,but CPSP is still produced after VAST lobectomy.This study provides niew ideas for clinicians to reduce the incidence of CPSP by exploring the influential factors of chronic postoperative pain after VATS in early Non-small cell lung Cancer,which is reported as follows.ObjectiveStudying the influencing factors of CPSP in patients with early non-small cell lung cancer treated with VATS lobectomy.MethodsA total of 206 patients who underwent thoracoscopy pulmonary lobectomy who met the study criteria from October 1,2017 to October 31,2019 in the Fifth Affiliated Hospital of Zhengzhou University were collected.Statistics of 192 cases were actually completed.The visual analogue scale(VAS)was used to assess the pain scores on the 1st to 3rd day after operation,questionnaire the patients with the short-form of brief pain inventory at 2 months after surgery,and the numerical rating scale(NRS)was used to assess the pain level of the patients at the second month.Based on whether or not chronic post-surgical pain(CPSP)occurred in the second month after surgery,patients were divided into two groups,namely the CPSP group and the non-CPSP group.Analysising 11 factors by t test,t' test,chi square test,Logistic regression etc,including age,sex,marital status,smoking status,drinking status,body mass index(BMI),postoperative pain scores for 1-3 days,operation time(min),and postoperative chest drainage tube indwelling time(d),pathotype,pathologic staging,by statistical methods.Results(1)Among the 192 cases who completed the whole process,91 patients had CPSP,accounting for about 47.4%.There were no CPSP in 101 patients,accounting for 52.6%.Compared with the non-CPSP group(n=101),the CPSP group(n=91):the pain score was higher after 1-3 days,and the difference was statistically significant(P<0.05);the average age of the patients was lower,and the difference was statistically significant.Significance(P<0.05);the proportion of female patients was higher,and the difference was statistically significant(P<0.05).There were no significant differences in marital status,smoking status,drinking status,BMI,operation time,postoperative chest wall drainage tube indwelling time,pathological classification,and pathological staging between the two groups(all P>0.05).(2)CPSP was used as the outcome variable.Postoperative pain score,gender,age,and postoperative chest wall drainage tube indwelling time were used as independent variables.Logistic regression analysis showed that increased age(P<0.05,OR=0.830,95%CI:0.73-0.943)is a protective factor for CPSP,female(P<0.05,OR=10.566,95%C1:1.059-105.432)and higher pain score of 1-3 days after surgery(P<0.05,OR=15.533,95%CI:6.627-36.410)are indenpendent risk factors for CPSP,and the indwelling time of the chest wall drainage tube after surgery(P>0.05,OR=0.0862,95%CI:0.439-1.694)is not an independent influencing factor for CPSP.Conclusions(1)Patients with severe acute pain have a higher risk of CPSP.(2)Younger patients have a higher risk of CPSP.(3)Famle patients have a higher risk of CPSP.