Effects of methylprednisolone on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery: A randomized controlled trial

Shi, Wei; Chen, Ying; Zhang, Meng‐Qiu; Che, Guowei; Yu, Hai

doi:10.1016/j.jclinane.2021.110526

Cited by 9 publications

(29 citation statements)

References 41 publications

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“…Where necessary, continuous data were translated into categorical variables. We converted the nausea and vomiting scores from the trial by Shi et al into dichotomous variable of ''yes'' and ''no'' according to the score interval [21].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the utility of perioperative MP remains controversial for postoperative analgesia. Moreover, the possible side effects of MP, including an increased risk of infection, delayed wound healing, and transient hyperglycemia, should be considered [10,[18][19][20][21]. Therefore, further high-quality evidence is needed regarding the clinical effects and safety of perioperative methylprednisolone in lung surgeries.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials

An³

et al. 2022

Pain Ther

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Introduction:The administration of methylprednisolone (MP) is a component of perioperative multimodal analgesia that mitigates the potentially deleterious effects of postoperative pain and opioid consumption. However, a systematic evaluation of the efficacy and safety of MP is lacking. The present systematic review and meta-analysis was performed to quantify the potential clinical benefits and risks of perioperative MP in lung surgery. Methods: We searched seven electronic databases for randomized controlled trials (RCTs) comparing MP with placebo. Coprimary outcomes were rest pain scores, dynamic pain scores, and cumulative morphine equivalent consumption within 24 h postoperatively. Results: A total of 11 trials including 643 participants were selected for our meta-analysis. The results demonstrated that the MP group had a significant difference in coprimary outcomes (rest pain scores, dynamic pain scores, and cumulative morphine equivalent consumption) compared with the placebo group; nevertheless, the improvement was not clinically meaningful based on minimum clinically important differences (MCID). Notably, MP administration reduced serum levels of interleukin (IL)-6 at 6 h (weighted mean difference -20.49 pg/mL; 95% CI -29.94 to -11.04), and decreased the incidence rate of acute lung injury (rate ratio 0.18; 95% CI 0.03-0.98) and cognitive dysfunction (rate ratio 0.43; 95% CI 0.21-0.88) compared with the placebo group. Conclusions: Our findings suggest that the administration of MP contributed to an insignificant relief in acute postoperative pain for lung surgery in a clinical setting. Future studies should focus on exploring the role of MP in reducing pulmonary and surgical-related complications after lung surgery.Xi Fu and Xin Ye contributed equally as co-first authors.Yi-Feng Ren, Jing Dong, and Xin Ye contributed equally as co-correspondence authors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials

An³

et al. 2022

Pain Ther

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“…the proportion of SAME was 33% in patients undergoing thoracoscopic lung surgery with PCIA (sufentanil 3 μg/kg + tropisetron 15 mg + dexmedetomidine 200 μg in 200 ml normal saline, infusion rate of 2 ml/h) [ 2 ]. We hypothesized that 50% of patients achieving SAME would be clinically significant when using the trial interventions.…”

Section: Methodsmentioning

confidence: 99%

“…No, 37 Guoxue Alley, Chengdu 610041, China. 2 Department of Anesthesiology, The First People's Hospital of Neijiang, Neijiang 641000, China. 3 Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu 610017, China.…”

Section: Abbreviationsmentioning

confidence: 99%

“…Although minimally invasive techniques are increasingly popular, postoperative pain is one of the most common complaints from patients undergoing video-assisted thoracoscopic surgery (VATS). Of note, patients can still experience moderate-severe pain after VATS [ 1 , 2 ]. Pain relief after VATS continues to be a challenging issue for anesthesiologists caring for these patients.…”

Section: Introductionmentioning

confidence: 99%

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Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial

Tian

Zhao

et al. 2022

BMC Anesthesiol

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Background Opioids remain the mainstream therapy for post-surgical pain. The choice of opioids administered by patient-controlled intravenous analgesia (PCIA) for thoracoscopic lung surgery is unclear. This study compared 3 opioid analgesics for achieving satisfactory analgesia with minimal emesis (SAME). Methods This randomized clinical trial enrolled patients scheduled for thoracoscopic lung surgery randomized to receive 1 of 3 opioids for PCIA: oxycodone (group O), hydromorphone (group H), and sufentanil (group S). The primary outcome was the proportion of subjects achieving SAME, i.e., no-to-mild pain (pain score < 4/10) with minimal nausea/vomiting (PONV score < 2/4) when coughing during the pulmonary rehabilitation exercise in the first 3 postoperative days. Results Of 555 enrolled patients, 184 patients in group O, 186 in group H and 184 in group S were included in the final analysis. The primary outcome of SAME was significantly different among group O, H and S (41.3% vs 40.3% vs 29.9%, P = 0.043), but no difference was observed between pairwise group comparisons. Patients in groups O and H had lower pain scores when coughing on the second day after surgery than those in group S, both with mean differences of 1 (3(3,4) and 3(3,4) vs 4(3,4), P = 0.009 and 0.039, respectively). The PONV scores were comparable between three groups (P > 0.05). There were no differences in other opioid-related side effects, patient satisfaction score, and QoR-15 score among three groups. Conclusions Given clinically relevant benefits detected, PCIA with oxycodone or hydromorphone is superior to sufentanil for achieving SAME as a supplement to multimodal analgesia in patients undergoing thoracoscopic lung surgery. Trial registration This study was registered at (ChiCTR2100045614, 19/04/2021).

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Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia

Wang,

Guo,

Sun

et al. 2024

JAMA Netw Open

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ImportanceThe efficacy of a semirecumbent position (SRP) in reducing postoperative hypoxemia during anesthesia emergence is unclear despite its widespread use.ObjectiveTo determine the differences in postoperative hypoxemia between patients in an SRP and a supine position.Design, Setting, and ParticipantsThis randomized clinical trial was performed at a tertiary hospital in China between March 20, 2021, and May 10, 2022. Patients scheduled to undergo laparoscopic upper abdominal surgery under general anesthesia were enrolled. Study recruitment and follow-up are complete.InterventionsPatients were randomized to 1 of the following positions at the end of the operation until leaving the postanesthesia care unit: supine (group S), 15° SRP (group F), or 30° SRP (group T).Main Outcomes and MeasuresThe primary outcome was the incidence of postoperative hypoxemia in the postanesthesia care unit. Severe hypoxemia was also evaluated.ResultsOut of 700 patients (364 men [52.0%]; mean [SD] age, 47.8 [11.3] years), 233 were randomized to group S (126 men [54.1%]; mean [SD] age, 48.2 [10.9] years), 233 to group F (122 men [52.4%]; mean [SD] age, 48.1 [10.9] years), and 234 to group T (118 women [50.4%]; mean [SD] age, 47.2 [12.1] years). Postoperative hypoxemia differed significantly among the 3 groups (group S, 109 of 233 [46.8%]; group F, 105 of 233 [45.1%]; group T, 76 of 234 [32.5%]; P = .002). This difference was statistically significant for groups T vs S (risk ratio [RR], 0.69 [95% CI, 0.55-0.87]; P = .002) and groups T vs F (RR, 0.72 [95% CI, 0.57-0.91]; P = .007), but not for groups F vs S (RR, 0.96 [95% CI, 0.79-1.17]; P = .78). Severe hypoxemia also differed among the 3 groups (group S, 61 of 233 [26.2%]; group F, 53 of 233 [22.7%]; group T, 36 of 234 [15.4%]; P = .01). This difference was statistically significant for groups T vs S (RR, 0.59 [95% CI, 0.41-0.85]; P = .005).Conclusions and RelevanceIn this randomized clinical trial of SRP during anesthesia recovery in patients undergoing laparoscopic upper abdominal surgery, postoperative hypoxemia was significantly reduced in group T compared with group F or group S.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2100045087

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Effects of methylprednisolone on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery: A randomized controlled trial

Cited by 9 publications

References 41 publications

Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial

Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia

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