Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Abstract

Objective ‒ to explore the need for additional analgesia during surgical interventions on the respiratory organs, by evaluating the consumption of opioids in the postoperative period.Materials and methods. The data of 157 patients, who underwent open surgery for lung cancer were analyzed. Patients were divided into four groups: Multimodal analgesia group (n=39): 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours with epidural analgesia using ropivacaine 2 mg/ml (3‒14 mL/h). Thoracic epidural analgesia group (n=37): epidural analgesia: in the postoperative period – ropivacaine 2 mg/ml (3‒14 mL/h). Preemptive analgesia group (n=41): according to the concept of preemptive analgesia ‒ 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period ‒ dexketoprofen and paracetamol were administered every 8 hours. Control group (n=40): patients received dexketoprofen 50 mg and, if necessary, an opioid analgesic. Pain syndrome was assessed using a visual analog scale from 0‒100 mm.Results. The lowest average dose of morphine consumption was not statistically significantly different in the multimodal analgesia and preemptive analgesia groups (p=0.933), and was significantly lower than in the control and thoracic epidural analgesia groups.Conclusions. The use of a preventive approach to perioperative analgesia in thoracic surgery, which involves the use of paracetamol and dexketoprofen, is not statistically significantly different in terms of pain indicators and the dose and number of morphine prescriptions compared to intravenous administration of paracetamol and dexketoprofen in combination with epidural ropivacaine analgesia (p>0.05).