The retrospective consideration of postoperative analgesia in the patients who undergo rats (robot-assisted thoracic surgery) – Thoracic epidural analgesia vs intercostal nerve block via surgical field with IV-PCA

Abstract

Introduction Robot-Assisted Thoracic Surgery (RATS) is new technique compared with Video-assisted thoracic surgery (VATS) or Open thoracotomy. (1) Though the advantage of RATS, which brings clearer surgical vision three dimensionally, has been reported gradually, There are not so many articles available about postoperative analgesia in RATS and adequate postoperative analgesia of RATS has not been considered. The incision is smaller for each but the numbers of those are not less. For the robotic devices moving intercostal space flexibly, the pain could be severer in RATS than we imagined. Methods We conducted the retrospective comparison of analgesic effects between thoracic epidural analgesia (TEA) and intercostal nerve block (ICNB) combined with IV PCA of fentanyl in the patients who underwent RATS. The pain with numerical rating scale on 0 to 10 on 0,1,2,5 of postoperative day (POD), requirement of supplemental analgesic in 24hrs after surgery, postoperative hypotension, nausea, duration of bed rest from surgery, and duration after surgery to discharge were investigated in the RATS patients between Jan. 1st,2017 and March 31st, 2018. It was approved IRB of our institution. In order to test differences between means, the Student's T-test was applied in case of normal distribution. In case of abnormal distribution, the NRS score or incidence were analyzed the Pearson chi-squared test and Mann-Whitney U test were used. Variation of NRS were performed repeated measure ANOVA as treated continuous parameter. We considered P Results One hundred and seven patients were enrolled into the study. (Group E = 31, group I = 76). NRS on POD1 was significantly higher in Group I than Group E (3 vs 2, P Discussion TEA with opioid provided well analgesia on POD1 and which needed less supplemental analgesics postoperatively than ICNB combined with IV PCA. The combination of ICB and IVPCA may indicate not enough for postoperative pain in the patients who undergo RATS. We need select carefully thoracic analgesic methods for RATS including other blocks in future.