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  P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27723

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    P3.15-18 - Comparison of Pain Control Effects and Side Effects Early After VATs Lobectomy Between IV-PCA, Epidural-PCA and On-Q (ID 13846)

    12:00 - 13:30  |  Author(s): Seokjin Haam
    • Abstract
    • Slides

    Background
    

    Video-Assisted-Thoracic Surgery (VATS) is widely used as a standard surgical treatment in non-small cell lung cancer (NSCLC), the postoperative pain is reduced rather than before, but postoperative pain management is still important because the pain is a problem in itself and can cause other respiratory complications. So we compared the pain control effects and side effects of intravenous (IV) patient-controlled analgesia (PCA), epidural PCA, and continuous local anesthesia infusion (On-Q), the most commonly used pain management modalities after VATs lobectomy.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Total 94 patients who underwent VATs lobectomy in this center with NSCLC from January 2014 to August 2015 were analyzed. Of these 94 patients, 28 had epidural PCA, 36 had IV-PCA, and 30 had On-Q for postoperative pain management. The degree of pain was assessed by NPIS (numeric pain intensity scale), and we analyze NPIS from immediate postoperative period to 48 hours after operation by postoperative day. The incidence of side effects associated with pain control devices and early discontinuation due to side effects were analyzed.

    4c3880bb027f159e801041b1021e88e8 Result
    

    The mean value of NPIS on the day of surgery was 6.04 ± 2.56 in the epidural PCA group, 4.75 ± 2.35 in the IV-PCA group, and 5.27 ± 1.87 in the On-Q group and there was no statistically significant difference. NPIS values were decreased in all three groups until 48 hours postoperatively, but there was no significant difference between groups. The incidence of side effects related to pain control devices up to 48 hours after operation was the highest in the IV-PCA group (36.1%, 13/36), in the epidural PCA group (35.7%, 10/28) and in the On-Q group (10.0%, 3/30) and there was statistically significance (p=0.032). The rate of early discontinuation of the pain control device due to side effects was 33.3% (12/36) in the IV-PCA group, 25.0% (7/28) in the epidural PCA group, and 6.7% (2/30) in the On-Q group (p = 0.032).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    The effects of pain control after VATs lobectomy in NSCLC patients were not significantly different in epidural-PCA, IV-PCA, and On-Q but On-Q was superior in terms of side effects and early discontinuation of pain control device. Continuous extrapleural infusion of local anesthetic via On-Q has less systemic side effects and higher procedural stability than PCA. Therefore, On-Q may be sufficient to replace PCA in pain control after VATs lobectomy in NSCLC patients.

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