Postoperative Analgesia in Video-Assisted Thoracoscopic Surgery: A Retrospective Analysis

Background. Lobectomy by video-assisted thoracic surgery (VATS) has become a well-established and widespread therapeutic method for treating early lung cancer. However, VATS, especially VATS lobectomy, is still associated with moderate acute postoperative pain. The optimal strategy for postoperative analgesia after VATS lobectomy remains undetermined. Anesthesiologists and surgeons thus require an evidence-based VATS pain management approach. Methods. We retrospectively analyzed 352 patients who underwent VATS (either lobectomy or wedge resection). The patients were divided into four groups for comparative analysis of analgesic effects and safety: Group A, patient-controlled analgesia (PCA); Group B, PCA + flurbiprofen axetil (FA); Group C, PCA + FA + tramadol hydrochloride; and Group D, PCA + FA + a buprenorphine transdermal system (BTDS). Results. All 352 patients were included in the primary analysis. The analgesic effect in Group D was significantly better than that in the other three groups on postoperative days 2 and 3 (P = 0.035 and P = 0.001, respectively). Patients in Group D had better outcomes with respect to the postoperative day of chest tube removal (P = 0.000), volume of chest tube drainage (P = 0.024), and postoperative day of discharge (P = 0.000). However, the medical expense of hospitalization was not significantly different among the four groups (P = 0.809). Conclusions. Multimodal analgesia involving PCA + FA + BTDS provides effective analgesia; fewer analgesia-related complications; and a reduced patient economic burden, healthcare workload, and opioid requirement.