Korean J Pain.  2024 Oct;37(4):354-366. 10.3344/kjp.24173.

Impact of general anesthesia type on chronic postsurgical pain following video-assisted thoracoscopic surgery for lung cancer: a retrospective propensity-matched cohort study

• Yoon SH
• Choi S
• Yoon S
• Na KJ
• Bahk J
• Lee HJ

• KMID: 2559697
• DOI: http://doi.org/10.3344/kjp.24173

Abstract

Background
Anesthetic agents are potential modifiable factors that can mitigate chronic postsurgical pain (CPSP) development. This study aimed to investigate the association between propofol-based total intravenous anesthesia (TIVA) and the occurrence of CPSP following video-assisted thoracoscopic surgery (VATS) for lung cancer resection.
Methods
This single-center retrospective cohort study included adult patients with lung cancer who underwent elective VATS between January 2018 and December 2022. Patients were divided based on the maintenance anesthetic used (propofol vs. sevoflurane). The primary outcome was the presence of CPSP, defined as any level of surgical site pain recorded within 3–6 months postoperatively. The authors investigated the association between anesthetic agents and CPSP using propensity score matching with stabilized inverse probability of treatment weighting (sIPTW) to adjust for confounders. Additionally, multivariable logistic regression was used to further adjust for intraoperative opioid use that sIPTW could not account for. The robustness of these associations was evaluated using the E-value.
Results
Of the 833 patients analyzed, 461 received propofol and 372 sevoflurane. The overall incidence of CPSP was 43.3%. After sIPTW, the use of TIVA was significantly associated with a lower incidence of CPSP (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.57–0.99, P = 0.041), and remained significant after adjusting for intraoperative remifentanil equivalent dose (OR: 0.73, 95% CI: 0.55–0.96, P = 0.026). The E-values were 1.08 and 1.17, respectively.
Conclusions
Propofol-based TIVA is associated with reduced CPSP occurrence in VATS for lung cancer. Further prospective studies are needed to confirm the results.

Keyword

Anesthesia; Intravenous; Anesthetics; Lung Neoplasms; Pain; Postoperative; Propofol; Thoracic Surgery; Video-Assisted

Figure

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  Fig. 1 Flow chart of the study. VATS: video-assisted thoracoscopic surgery.

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  Fig. 2 Covariate balance plot of the distribution of standardized mean differences of covariates between the two groups before and after stabilized inverse probability of treatment weighting. ASA: American Society of Anesthesiologists, NP: neuropsychiatric, POD: postoperative day, BMI: body mass index.

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  Fig. 3 Results from different logistic models on the association between propofol-based total intravenous anesthesia and risk of chronic postsurgical pain. sIPTW: stabilized inverse probability of treatment weighting, CI: confidence interval.

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