Changes in analgesic strategies for lobectomy from 2009 to 2018

Theresa Lo; Robin Schiller; Karthik Raghunathan; Vijay Krishnamoorthy; Oliver K Jawitz; Srinivas Pyati; Thomas Van De Ven; Raquel R Bartz; Annemarie Thompson; Tetsu Ohnuma

doi:10.1016/j.xjon.2021.03.015

Changes in analgesic strategies for lobectomy from 2009 to 2018

JTCVS Open. 2021 Mar 26:6:224-236. doi: 10.1016/j.xjon.2021.03.015. eCollection 2021 Jun.

Authors

Theresa Lo^{1

2}, Robin Schiller^{1

3}, Karthik Raghunathan^{1

4}, Vijay Krishnamoorthy^{1

2}, Oliver K Jawitz⁵, Srinivas Pyati^{1

4}, Thomas Van De Ven^{1

4}, Raquel R Bartz^{1

2}, Annemarie Thompson^{1

3}, Tetsu Ohnuma^{1

2}

Affiliations

¹ Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
² Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
³ Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
⁴ Division of Veterans Affairs Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
⁵ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Abstract

Objective: To evaluate trends in the use of epidural analgesia and nonopioid and opioid analgesics for patients undergoing lobectomy from 2009 to 2018.

Methods: We queried the Premier database for adult patients undergoing open, video-assisted, and robotic-assisted lobectomy from 2009 to 2018. The outcome of interest was changes in the receipt of epidural analgesia and nonopioid and opioid analgesics as measured by charges on the day of surgery. We also evaluated postoperative daily opioid use. We used multivariable logistic and linear regression models to examine the association between the utilization of each analgesic modality and year.

Results: We identified 86,308 patients undergoing lobectomy from 2009 to 2018 within the Premier database: 35,818 (41.5%) patients had open lobectomy, 35,951 (41.7%) patients had video-assisted lobectomy, and 14,539 (16.8%) patients had robotic-assisted lobectomy. For all 3 surgical cohorts, epidural analgesia use decreased, and nonopioid analgesics use increased over time, except for intravenous nonsteroidal anti-inflammatory drugs. Use of patient-controlled analgesia decreased, while opioid consumption on the day of surgery increased and postoperative opioid consumption did not decrease over time.

Conclusions: In this large sample of patients undergoing lobectomy, utilization of epidural analgesia declined and use of nonopioid analgesics increased. Despite these changes, opioid consumption on day of surgery increased, and there was no significant reduction in postoperative opioid consumption. Further research is warranted to examine the association of these changes with patient outcomes.

Keywords: COX-2, cyclooxygenase-2; FDA, Food and Drug Administration; ICD, International Classification of Diseases; IV, intravenous; NSAID, nonsteroidal anti-inflammatory drug; PCA, patient-controlled analgesia; PME, parental morphine equivalent; PO, per os, oral; POD, postoperative day; RATS, robotic-assisted thoracoscopic surgery; VATS, video-assisted thoracoscopic surgery; epidural analgesia; lobectomy; multimodal analgesia; nonopioid analgesia; robotic-assisted thoracoscopic surgery; thoracic surgery; thoracotomy; video-assisted thoracoscopic surgery.