Economic Expendiency of Pre-Emptive Analgesia in Patients in Thoracic Surgery

Abstract

Introduction. According to the 2020 database of the World Health Organization, unfortunately lung cancer ranks the second place among the new cases of cancer. One of the main causes of the lung cancer is tobacco smoking. More than 20% of the adult population are daily smokers, and the tobacco epidemic tends to grow steadily. Increasing number of patients who undergoing thoracotomy contributes to the constant search for perioperative anesthesia and it’s improvement.
 Objective: to compare different methods of perioperative analgesia in thoracic surgery and to determine the most effective and cost-effective method.
 Materials and methods. There were analyzed 80 lung cancer patients who underwent open access surgery. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours, + epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative period - ropivacaine 2 mg/ml (3-14 ml/h). Group B: epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative - ropivacaine 2 mg/ml (3-14 ml/h). Group C: according to the concept of preemptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours. Group D: No pre-emptive analgesia and no epidural analgesia, morphine analgesia intravenous as needed. The severity of the pain syndrome was assessed by the numerological rating scale (NRS) after 3, 6, 12, 24, 32 hours.
 Results and discussion. There were not observed any statistically significant differences in the subgroups by age, body weight, duration of surgery and blood loss (p> 0.05). Patients of the Group A had the lowest level of pain, and only one patient required additional analgesia. There were no statistically significant differences in the severity of the pain syndrome between patients of the group B and the group C at all stages of the study (p <0.05). Using of the pre-emptive analgesia method with the use of the multimodal analgesia, but without the use of epidural anesthesia has the benefit in the amount of 728 hryvnias prevails.