All patients were consecutively recruited on the day before surgery. After written informed consent was obtained, baseline questionnaires were completed. Follow-ups after surgery for pain evaluation were performed on postoperative days (POD) 1, 3, 7, 14, 21, and 30 and monthly thereafter until pain resolution was reached or up to 6 months after surgery; the sessions were conducted by face-to-face interviews during the hospital stay or telephone interviews after discharge. Loss to follow-up was defined as the patient not being contacted during two consecutive follow-ups.
A standard perioperative pain management protocol was performed. Multimodal analgesia during surgery included the following: 1) corticosteroids, such as intravenous injection of methylprednisolone 40–80 mg before induction; 2) continuous infusion of dexmedetomidine at a rate of 0.4–0.6 μg/kg/h until incision closure; 3) short-acting opioids, including intermittent intravenous injection of sufentanil with a total dose of 0.5–1.0 μg/kg and continuous infusion of remifentanil 0.1–0.2 μg/kg/min until the end of surgery; and 4) flurbiprofen 100 mg or parecoxib 40 mg intravenously administered before the end of surgery when no contraindication presented. At the end of surgery, patient-controlled intravenous analgesia (PCIA) with sufentanil was provided to each patient for at least 72 hours. The PCIA device was initially set to deliver sufentanil at a rate of 2 μg/hour (solution 1 μg/ml) and a bolus of sufentanil 3 μg on request with a lockout time of 15 minutes. Background infusion was stopped if the worst pain score was <= 3 or opioid-related side effects (such as nausea and vomiting and dizziness) were reported during follow-ups. If severe opioid-related side effects persisted despite pharmacological treatment, PCIA was stopped at the request of the patient.
In wards, nonsteroidal anti-inflammatory drugs or COX-2 inhibitors were used as needed based on the surgeons’ preference. If patients reported pain with neuropathic characteristics, such as numbness and burning, gabapentin was added. Immediate-release oxycodone (5 mg) or tramadol (100 mg) was administered orally for rescue analgesia. Oral sustained-release oxycodone (5 mg every 12 hours) or a transdermal fentanyl patch (25 μg/hour for 72 hours) was provided for persistent severe pain after cessation of PCIA. Pain consultations were held when necessary.
A standard perioperative pain management protocol was performed. Multimodal analgesia during surgery included the following: 1) corticosteroids, such as intravenous injection of methylprednisolone 40–80 mg before induction; 2) continuous infusion of dexmedetomidine at a rate of 0.4–0.6 μg/kg/h until incision closure; 3) short-acting opioids, including intermittent intravenous injection of sufentanil with a total dose of 0.5–1.0 μg/kg and continuous infusion of remifentanil 0.1–0.2 μg/kg/min until the end of surgery; and 4) flurbiprofen 100 mg or parecoxib 40 mg intravenously administered before the end of surgery when no contraindication presented. At the end of surgery, patient-controlled intravenous analgesia (PCIA) with sufentanil was provided to each patient for at least 72 hours. The PCIA device was initially set to deliver sufentanil at a rate of 2 μg/hour (solution 1 μg/ml) and a bolus of sufentanil 3 μg on request with a lockout time of 15 minutes. Background infusion was stopped if the worst pain score was <= 3 or opioid-related side effects (such as nausea and vomiting and dizziness) were reported during follow-ups. If severe opioid-related side effects persisted despite pharmacological treatment, PCIA was stopped at the request of the patient.
In wards, nonsteroidal anti-inflammatory drugs or COX-2 inhibitors were used as needed based on the surgeons’ preference. If patients reported pain with neuropathic characteristics, such as numbness and burning, gabapentin was added. Immediate-release oxycodone (5 mg) or tramadol (100 mg) was administered orally for rescue analgesia. Oral sustained-release oxycodone (5 mg every 12 hours) or a transdermal fentanyl patch (25 μg/hour for 72 hours) was provided for persistent severe pain after cessation of PCIA. Pain consultations were held when necessary.
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