Risk factors for moderate-to-severe pain in PACU in patients undergoing thoracic surgery / 中华麻醉学杂志

ABSTRACT

Objective:To identify the risk factors for moderate-to-severe pain in postanesthesia care unit (PACU) in the patients undergoing thoracic surgery.Methods:The medical records of patients of both sexes, aged 18-80 yr, of American Society of Anesthesiologists(ASA) physical status Ⅰ-Ⅲ, transferred to PACU with tracheal intubation from January 2019 to January 2020, were retrospectively collected.Combined intravenous-inhalational anesthesia was used during surgery.The patient′s age, gender, ASA physical status, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, and history of immune system disease were collected.The operation method, type of operation, operation time, intraoperative nerve block and use of opioids and dexmedetomidine were also collected.The consumption of rescue analgesics during PACU, occurrence of nausea and vomiting, and length of stay in PACU were also collected.Patients were divided into moderate-to-severe pain group (VAS score>3 points) and non-moderate-to-severe pain group (VAS score≤3 points) according to the VAS scores at rest and during activity at 10 min after extubation in PACU.Logistic regression analysis was used to identity the risk factors for moderate-to-severe pain in PACU.Results:A total of 1 698 patients were included in this study, the incidence of moderate-to-severe pain at rest was 46.70%, and the incidence of moderate-to-severe pain during activity was 54.12%.The results of logistic regression analysis showed that female, radical resection of esophageal cancer, mediastinal surgery, internal fixation for rib/sternal surgery were risk factors for moderate-to-severe pain in PACU, and increasing age, endoscopic surgery, intraoperative use of nerve block and dexmedetomidine were protective factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery ( P<0.05). Conclusion:Female, radical resection of esophageal cancer, mediastinal surgery, and rib/sternal surgery are risk factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery; increasing age, endoscopic surgery, intraoperative use of nerve block and dexmedetomidine are protective factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery.