Postoperative Analgesia and Length of Hospital Stay After Surgery for Malignant Pleural Mesothelioma: A Retrospective Observational Study

Our plain-English summary of Postoperative Analgesia and Length of Hospital Stay After Surgery for Malignant Pleural Mesothelioma: A Retrospective Observational Study, by M. Kobata, K. Takeda, M. Taguchi, et al (Anesthesiology and Pain Medicine, 2024).

The study

• Authors: M. Kobata, K. Takeda, M. Taguchi, H. Okutani, T. Ide, A. Kido, K. Fujimoto, M. Hashimoto, R. Ueki, M. Hirose
• Journal: Anesthesiology and Pain Medicine
• Published: 2024;14(6):e150055
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleurectomy/decortication (P/D), a surgical procedure for malignant pleural mesothelioma (MPM), is a highly invasive surgery requiring prolonged hospitalization. Previous studies have reported that postoperative analgesia using regional anesthesia contributes to shorter hospital stays after surgery under general anesthesia by reducing acute postoperative pain. However, the association between postoperative analgesia and the length of hospital stay (LOHS) following P/D has not been evaluated.

Objectives: To evaluate the association between postoperative analgesia and postoperative LOHS after P/D.

Methods: This single-institution observational study enrolled consecutive adult patients undergoing P/D under general anesthesia, who postoperatively received either intertransverse process block (ITPB) or continuous intravenous (IV) fentanyl infusion as postoperative analgesia between March 2022 and February 2023.

Results: Among all enrolled patients with ASA physical status II or III (n = 60), postoperative analgesia was administered using either continuous ITPB (n = 19) or continuous IV fentanyl infusion (n = 41). Multivariable logistic regression analysis revealed that postoperative analgesia with continuous ITPB (P = 0.007), a lower incidence of major complications after surgery (P = 0.034), and female sex (P = 0.033) were significantly associated with a shorter postoperative LOHS. In subgroup analysis, patients who received continuous ITPB had significantly lower postoperative LOHS, lower postoperative serum C-reactive protein levels on postoperative day (POD) 3, and reduced acute postoperative pain on POD3 compared to those who received continuous IV fentanyl infusion.

Conclusions: Postoperative analgesia using continuous ITPB appears to be associated with a reduction in LOHS following P/D for MPM under general anesthesia.

Copyright © 2024, Kobata et al.

In plain English

This retrospective observational study, from a single hospital in Japan, looked at 60 consecutive adults who had pleurectomy/decortication, an operation for malignant pleural mesothelioma, between March 2022 and February 2023. It did not study asbestos exposure. The authors compared two kinds of pain relief after surgery: a continuous nerve block called intertransverse process block (ITPB), given to 19 patients, and a continuous intravenous fentanyl infusion, given to 41. In a statistical model, continuous ITPB was linked to lower odds of staying 21 days or more after surgery (odds ratio 0.14, 95% CI 0.03 to 0.59). Male sex and major complications were linked to higher odds. The median hospital stay after surgery was 17 days with ITPB and 22 days with fentanyl. On day 3, patients given ITPB had lower levels of C-reactive protein, a marker of inflammation, and less pain. They stayed longer in intensive care. The authors concluded that ITPB is likely associated with shorter stays and less pain. They noted the small number of patients, and that the two groups received different nerve blocks before surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective observational (cohort) study at a single institution, using medical records
• Who was studied: 60 consecutive adult patients who underwent pleurectomy/decortication (P/D) for malignant pleural mesothelioma under general anesthesia at Hyogo Medical University Hospital, Japan, between March 2022 and February 2023. 52 were male and 8 female.
• Exposure: Not asbestos. The comparison was the type of pain relief after surgery: continuous intertransverse process block (ITPB) with 0.125% levobupivacaine until postoperative day 3, versus continuous intravenous fentanyl infusion (25 to 30 micrograms per hour) until postoperative day 3. The ITPB group had a single-shot ITPB before surgery. The fentanyl group had a single-shot thoracic paravertebral block (TPVB) before surgery.
• Main results:
  • 19 patients (31.7%) received continuous ITPB and 41 patients (68.3%) received continuous IV fentanyl infusion
  • In multivariable analysis, continuous ITPB was associated with lower odds of a postoperative hospital stay of 21 days or more: odds ratio 0.14 [95% CI 0.03 to 0.59], P = 0.007
  • In the same analysis, male sex was associated with higher odds of a hospital stay of 21 days or more: odds ratio 8.83 [95% CI 1.19 to 65.3], P = 0.033
  • In the same analysis, major complications (Clavien-Dindo grade III or higher) were associated with higher odds of a hospital stay of 21 days or more: odds ratio 5.84 [95% CI 1.14 to 29.97], P = 0.034
  • Median postoperative hospital stay was 22 days [25th to 75th percentile 20 to 31] in the fentanyl group (n = 41) and 17 days [14 to 24] in the ITPB group (n = 19), P = 0.005
  • Median ICU stay after surgery was longer in the ITPB group: 4 days [3 to 4] versus 3 days [2 to 4] in the fentanyl group, P = 0.032
  • Serum C-reactive protein on postoperative day 3 was 9.14 (SD 6.50) mg/dL in the fentanyl group and 5.07 (SD 4.04) mg/dL in the ITPB group, P = 0.017
  • Pain at rest on postoperative day 3 was significantly lower with ITPB. A pain score of 4 or higher was recorded in 5 of 41 fentanyl patients (12.2%) and 0 of 19 ITPB patients, P = 0.045.
  • Major complications occurred in 45 of 60 patients (75.0%), mostly air leak (n = 42). The two groups did not differ significantly (73.2% fentanyl versus 78.9% ITPB, P = 0.627).
  • No postoperative adverse events led to early stopping of either pain-relief method
• The authors' conclusion: The authors concluded that continuous ITPB for postoperative pain relief is likely associated with a shorter hospital stay and less acute postoperative pain after pleurectomy/decortication for malignant pleural mesothelioma, compared with continuous IV fentanyl infusion
• Limitations the authors state:
  • Small number of patients
  • The two groups received different single-injection nerve blocks before surgery (ITPB versus TPVB), and an intraoperative nociception index differed between groups
  • Subgroup analyses can be misleading, and this one did not identify a mechanism explaining the association

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleurectomy/Decortication (P/D).

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