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A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain

Authors Kuroda H, Mizuno H, Dejima H, Watanabe K, Yoshida T, Naito Y, Sakao Y

Received 29 July 2017

Accepted for publication 13 September 2017

Published 15 November 2017 Volume 2017:10 Pages 2643—2648

DOI https://doi.org/10.2147/JPR.S147691

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon

Hiroaki Kuroda,1 Hitomi Mizuno,2 Hitoshi Dejima,1 Kiyoe Watanabe,2 Tatsuya Yoshida,3 Yumiko Naito,2 Yukinori Sakao1

1Department of Thoracic Surgery, 2Department of Nursing, 3Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan

Background: Thoracoscopic surgery (TS) has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aims of this study were to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS).
Materials and methods: A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on the NRS score.
Results: Of the 524 patients, mild pain was noted in 87% patients on the day of the operation and in 75.6% patients on ambulation. The mean NRS score was 1.83±1.49 on the day of the operation and 2.73±1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Multivariate analysis showed that high surgical stress significantly influenced pain scores. Reduction in pain with an NRS score of ≥1 was significant with the addition of pentazocine hydrochloride (p<0.01) and flurbiprofen (p<0.01). Interestingly, the addition of tramadol was borderline efficacious (p=0.05) in patients with an NRS score of >3 on ambulation.
Conclusion: A small number of patients have moderate-to-severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of ≥3.

Keywords: tramadol, thoracoscopic surgery, ambulation, NRS, postoperative pain

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