Résumé
Objective:To improve the understanding of acute pain after thoracoscopic surgery in patients with early-stage lung adenocarcinoma, to analyze and screen out the independent risk factors that may induce acute postoperative pain. The patients' surgery experience may get improved through the corresponding timely and effective interventions.Methods:We retrospectively reviewed the clinical data of 204 patients with early-stage lung adenocarcinoma who were treated by a single medical team of our center from May 2021 to October 2021, and analyzed the assessment results of acute postoperative pain. Patients were grouped according to the general condition, past medical history, social and spiritual attributes, lesion characteristics, surgical approaches and anesthetic methods. Comparison of proportions of acute postoperative pain between the groups were made, and independent risk factors were identified.Results:A total of 84 males and 120 females were enrolled, with a mean age of(57.9±11.5)years old and a median operation time of 120(110, 145) min. No serious complication or perioperative death occurred in the whole group. Postoperative pain control failed in 76 cases(37.3%), 24 cases(11.8%) suffered from severe postoperative pain, and 33 cases(16.2%) required additional intramuscular injection of strong analgesics after surgery. Those who were younger than 60 years old, with a university degree or above, received two-incision surgery, operated for more than 2 h, received general anesthesia only, or in a state of depression, had significantly higher rates of postoperative acute pain, compared with their respective control groups( P<0.05). The independent risk factors for acute pain after thoracoscopic surgery included age( P=0.002), history of alcoholism( P=0.014), number of incisions( P=0.016), operation time( P=0.010), depression status( P=0.037) and enhanced anesthetic method( P=0.012). Conclusion:A large amount of patients with early-stage lung cancer suffered from acute pain after thoracoscopic surgery, which seriously affected their treatment experience and even quality of life. Young patients with a history of alcoholism and depression status were high-risk groups for postoperative acute pain. Applying Uniportal video-assisted thoracoscopic surgery, reducing the operation time as much as possible, and choosing enhanced analgesic anesthesia represented by epidural block combined with general anesthesia might be effective ways to reduce the probability of acute postoperative pain.
Résumé
Resumen: El abordaje laparoscópico ha revolucionado la cirugía abdominal en los últimos 30 años, y ahora los cirujanos son capaces de realizar operaciones sin realizar grandes incisiones a la pared abdominal. Así como la colecistectomía, apendicectomía y los procedimientos tubo-ováricos fueron los abordajes iniciales, la laparoscopía ahora ha incrementado su aplicabilidad a procedimientos mayores como histerectomía, procedimientos bariátricos y varias resecciones gastrointestinales y urológicas de tipo oncológico. Los avances tecnológicos han generado el desarrollo de muchas variaciones sobre el abordaje laparoscópico «tradicional o estándar¼. Los aspectos en el cuidado perioperatorio multimodal fueron asignados para alcanzar una recuperación más rápida después del procedimiento quirúrgico. Esto dependerá del tipo de cirugía realizada, de factores propios del paciente y de la presencia de comorbilidades. La duración de la recuperación después de la cirugía laparoscópica dependerá del procedimiento realizado, pudiendo ser tan corta como de una a dos semanas en procedimientos de tipo ambulatorio (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).
Abstract: Laparoscopy has revolutionized abdominal surgery over the past 30 years that enable surgeons to perform operations without making large abdominal incisions. As well as cholecystectomy, appendicectomy, and tubo-ovarian procedures, laparoscopy is now increasingly used for hysterectomy, bariatric procedures, and many gastrointestinal and urological cancer resections. Technological advances have resulted in the development of several variations on the «standard¼ laparoscopic approach. The multimodal perioperative care pathways were designed to achieve early recovery after surgical procedures. This depends upon the type of surgery that has been performed, and patient factors such as comorbidities. The duration of recovery after laparoscopic surgery depends on the procedure performed and can be as short as 1-2 weeks in day case procedures (visit http://www.painoutmexico.com to see the full article and recommendations).
Résumé
OBJECTIVE@#To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain after posterior lumbar surgery.@*METHODS@#Eighty-nine patients undergoing selective posterior lumbar surgery under general anesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received total intravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia (TIVA) combined with erector spinae plane block (ESPB), and 31 had TIVA combined with retrolaminar block (RLB). All the patients received patient-controlled intravenous analgesia (PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulse oximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h after the surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression within 48 h after the surgery were also recorded.@*RESULTS@#At 2, 8 and 12 h postoperatively, VAS scores in the ESPB group and RLB group were significantly lower than those in the control group; the scores were significantly lower in RLB group than in ESPB group ( < 0.05). Compared with that in the control group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLB groups, particularly in the latter group ( < 0.05). Two patients experienced nausea and vomiting and 1 patient complained of pruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinary retention in RLB group.@*CONCLUSIONS@#Ultrasound-guided RLB has better analgesic effect than ESPB for management of perioperative pain following posterior lumbar surgery.