Association Between Gabapentinoids and Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery.

OBJECTIVE: Perioperative gabapentinoids in general surgery have been associated with an increased risk of postoperative pulmonary complications (PPCs), while resulting in equivocal pain relief. This study's aim was to examine the utilization of gabapentinoids in thoracic surgery to determine the association of gabapentinoids with PPCs and perioperative opioid utilization. DESIGN: A multicenter retrospective cohort study. SETTING: Hospitals in the Premier Healthcare Database from 2012 to 2018. PARTICIPANTS: A total of 70,336 patients undergoing elective open thoracotomy, video-assisted thoracic surgery, and robotic-assisted thoracic surgery. INTERVENTIONS: Propensity score analyses were used to assess the association between gabapentinoids on day of surgery and the primary composite outcome of PPCs, defined as respiratory failure, pneumonia, reintubation, pulmonary edema, and noninvasive and invasive ventilation. Secondary outcomes included invasive and noninvasive ventilation, hospital mortality, length of stay, opioid consumption on day of surgery, and average daily opioid consumption after day of surgery. RESULTS: Overall, 8,142 (12%) patients received gabapentinoids. The prevalence of gabapentin on day of surgery increased from 3.8% in 2012 to 15.9% in 2018. Use of gabapentinoids on day of surgery was associated with greater odds of PPCs (odds ratio [OR] 1.19, 95% CI 1.11-1.28), noninvasive mechanical ventilation (OR 1.30, 95% CI 1.16-1.45), and invasive mechanical ventilation (OR 1.14, 95% CI 1.02-1.28). Secondary outcomes indicated no clinically meaningful associations of gabapentinoid use with opioid consumption, hospital mortality, or length of stay. CONCLUSIONS: Perioperative gabapentinoid administration in elective thoracic surgery may be associated with a higher risk of PPCs and no opioid-sparing effect.

Changes in analgesic strategies for lobectomy from 2009 to 2018.

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.

Post-traumatic Stress Disorder in Resident Physicians.

Background Research suggests that symptoms of post-traumatic stress disorder (PTSD) may be common in physicians who have experienced a traumatic event, but it is unclear if medical residents suffer from similar symptoms. Objective To determine the prevalence of PTSD symptoms in the resident physician population of the University of British Columbia based on the new Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) criteria. Method A link to an online questionnaire containing 27 questions, including residency training and year, as well as the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-fifth edition (PCL-5) was e-mailed and completed by the resident physicians of the University of British Columbia. Results Forty-three residents completed the survey and 38 had complete data. Mean PCL-5 score was 10.3 for the 38 subjects. Differences between PCL-5 score and resident year yielded the following: postgraduate year (PGY)-1=8.6; PGY-2=16.5; PGY-3=3.6; PGY-4=4.0; PGY-5=7.7. With respect to the type of traumatic event and PCL-5 score, the following was observed: Death=5.3, Violence=13.8, Medical Error=8.0, Bullying=38.0, None=45.0. The Kruskal-Wallis test showed no statistically significant differences in total PCL-5 score for PGY or type of traumatic event. Regardless of post-graduate year or trauma experience, four subjects out of 38 (10.5%) had a total PCL-5 score of 33 or greater, while one subject (2.5%) had a score greater than 50. Conclusion The results from this study conclude that resident physicians do suffer from PTSD symptoms at a rate higher than the average American population. As PTSD symptoms can often be very distressing and potentially affect work ethic negatively, further studies are indicated to better understand these symptoms and hopefully lead to better care in treating PTSD symptoms in resident physicians.

Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage, recovery, complications, and prognosis in video-assisted thoracic surgical lobectomy: a randomized, double-blinded, placebo-controlled trial.

BACKGROUND: Transcutaneous electrical acupoint stimulation (TEAS), a non-invasive and non-pharmacological adjunctive intervention for perioperative analgesia, may also reduce the incidence of postoperative pulmonary complications. The effect of TEAS on video-assisted thoracic surgical (VATS) patients is still unknown, however. The purpose of this study was to investigate the effects of TEAS of different frequency on perioperative anesthetic dosage, recovery, complications, and prognosis for patients undergoing VATS lobectomy. METHODS: Eighty VATS lobectomy patients with no previous experience of TEAS or acupuncture were randomly assigned to four groups: control (con), 2/100, 2, and 100 Hz. The last three experimental groups received TEAS at the indicated frequencies for 30 min before induction, during the operation, and for another 30 min 24 and 48 h after surgery. 2/100 Hz is a type of alternating frequency which goes between 2 and 100 Hz every 3 s. TEAS was administered over acupoints Neiguan, Hegu, Lieque, and Quchi on the sick lateral. Electrodes were applied to the patients in the control group, but no TEAS was used. Anesthetic dosage, blood gas analysis results, lung function indexes FEV1 and FVC, post-anesthesia care unit (PACU) status, postoperative complications, and quality of life scores were recorded and analyzed statistically. RESULTS: Intraoperative opioid consumption was lowest in the 2/100 Hz group, with statistical significance (con, P ≤ 0.001; 2 Hz, P ≤ 0.001; 100 Hz, P = 0.026). Compared with preoperative FEV1 and FVC, postoperative FEV1 and FVC were significantly lower in all groups; during one-lung ventilation, arterial oxygen partial pressure (PaO2) decreased more slowly in the 2/100 Hz group than in the con group (P = 0.042). Moreover, in the 2/100 Hz group extubation time was shorter (P = 0.038), visual analgesia scale score lower (P = 0.047), and duration of PACU stay shorter (P = 0.043) than in the con group. In the 100 Hz group incidence of postoperative nausea and vomiting (PONV) was lower than the con group (P = 0.044). In all groups mean postoperative physical component scores were significantly lower than mean preoperative scores. CONCLUSIONS: TEAS is a safe noninvasive adjunctive intervention for anesthesia management among patients undergoing VATS lobectomy. TEAS at 2/100 Hz can reduce intraoperative opioid dosage and slow the decrease of PaO2 during one-lung ventilation. It can also effectively reduce pain score, extubation time, and PACU stay immediately after surgery. Further, 100 Hz TEAS can reduce PONV morbidity.