Yabuki Shizuha, Kaiho Yu, Tarasawa Kunio, Ikumi Saori, Iwasaki Yudai, Imaizumi Takahiro, Fujimori Kenji, Fushimi Kiyohide, Yamauchi Masanori
Department of Anaesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Eur J Pain. 2025 Feb;29(2):e4774. doi: 10.1002/ejp.4774.
Lung cancer surgery is associated with a high incidence of chronic postsurgical pain (CPSP), which necessitates long-term analgesic prescriptions. However, while essential for managing pain, these have shown various adverse effects. Current guidelines recommend using peripheral nerve blocks over epidural anaesthesia for perioperative analgesia in minimally invasive thoracic surgery (MITS). However, the impact of perioperative analgesia on chronic analgesic prescriptions remains unclear. Therefore, this study investigated chronic analgesic prescription patterns following MITS in patients with lung cancer who received either perioperative epidural anaesthesia or nerve block.
We conducted a retrospective cohort study using data from the Japanese Diagnosis Procedure Combination database. Data were extracted from patients with primary lung cancer who underwent MITS between April 2018 and March 2022. Patients were divided into two groups based on the perioperative analgesia they received: the epidural anaesthesia group and the nerve block group. We compared the proportion of analgesic prescriptions 3-6 months postoperatively between both groups using multivariable logistic regression analysis. Inverse probability of treatment weighting was used to balance the covariates between the two groups.
Among the 38,719 eligible patients, 4513 (11.6%) were prescribed postoperative analgesics. We found no significant difference in the proportion of analgesic prescriptions between the epidural anaesthesia and nerve block groups (odds ratio, 1.00; 95% confidence interval, 0.99-1.01).
This nationwide retrospective study suggests that the choice between perioperative epidural anaesthesia or nerve block in patients with lung cancer undergoing MITS does not influence the proportion of postoperative chronic analgesic prescriptions.
肺癌手术与慢性术后疼痛（CPSP）的高发生率相关，这需要长期的镇痛处方。然而，虽然这些处方对于控制疼痛至关重要，但已显示出各种不良反应。目前的指南推荐在微创胸外科手术（MITS）中使用外周神经阻滞而非硬膜外麻醉进行围手术期镇痛。然而，围手术期镇痛对慢性镇痛处方的影响仍不清楚。因此，本研究调查了接受围手术期硬膜外麻醉或神经阻滞的肺癌患者在MITS后的慢性镇痛处方模式。
我们使用来自日本诊断程序组合数据库的数据进行了一项回顾性队列研究。数据提取自2018年4月至2022年3月期间接受MITS的原发性肺癌患者。根据患者接受的围手术期镇痛方式将其分为两组：硬膜外麻醉组和神经阻滞组。我们使用多变量逻辑回归分析比较了两组术后3至6个月镇痛处方的比例。采用治疗权重的逆概率来平衡两组之间的协变量。
在38719名符合条件的患者中，4513名（11.6%）患者术后开具了镇痛处方。我们发现硬膜外麻醉组和神经阻滞组之间镇痛处方的比例没有显著差异（优势比，1.00；95%置信区间，0.99 - 1.01）。
这项全国性的回顾性研究表明，在接受MITS的肺癌患者中，围手术期选择硬膜外麻醉或神经阻滞不会影响术后慢性镇痛处方的比例。
