The effects of body mass index on postoperative pain in patients undergoing thoracic paravertebral block after video-assisted thoracoscopic surgery: A retrospective analysis

Year 2022, Volume: 5 Issue: 5, 1431 - 1436, 25.09.2022

Gülay Ülger , Musa Zengin , Ramazan Baldemir

https://doi.org/10.32322/jhsm.1148292

Abstract

Aim: Postoperative pain is an important problem in patients undergoing video-assisted thoracic surgery (VATS). Thoracic paravertebral block (TPVB) is among the commonly used techniques for pain control after VATS. Despite the analgesic methods applied, the desired level of pain control can not be achieved in all patients. Therefore, clinicians and researchers are interested in factors affecting postoperative pain. One factor is the relationship between postoperative pain and body mass index (BMI). Although it has been reported that acute or chronic pain is more common in the general population with a BMI, the relationship between postoperative pain and BMI is still controversial. This study aims to investigate the effects of BMI on postoperative pain in patients who underwent TPVB in the treatment of pain after VATS.
Material and Method: Patients who had elective VATS and TPVB were included in the study. Patients who underwent TPVB with ultrasonography (USG) and postoperative intravenous (iv) morphine patient-control-analgesia (PCA) for postoperative analgesia were divided into three groups according to BMI. Group-I BMI: 18-24.99 kg/m2, Group-II BMI: 25-29.9 kg/m2, Group-III BMI: 30-40 kg/m2.
Results: 146 patients were included in the study. There was no significant difference between the postoperative 30th minute, 1st hour, 6th hour, 12th hour, and 24th-hour VAS values of the patients in Group-I, Group-II, and Group-III. There was no statistically significant difference in terms of morphine consumption, additional analgesic requirement, and complications in all three groups.
Conclusion: It was determined that there was no relationship between BMI and postoperative pain scores in the first 24 hours in patients who underwent TPVB after VATS. In addition, it was determined that postoperative morphine consumption and additional analgesic needs were not associated with BMI. Effective pain control can be achieved in all patients, regardless of BMI, with effective peripheral nerve blocks and analgesics using practical imaging techniques such as USG.

Keywords

Body mass index, postoperative pain, thoracic paravertebral block, visual analog scale, video-assisted thoracic surgery

References

• Sugiyama T, Kataoka Y, Shindo K, et al. Retrolaminar block versus paravertebral block for pain relief after less-invasive lung surgery: a randomized, non-inferiority controlled trial. Cureus 2021; 13: e13597.
• González-Callejas C, Aparicio VA, De Teresa C, Nestares T. Association of body mass index and serum markers of tissue damage with postoperative pain. The role of lactate dehydrogenase for postoperative pain prediction. Pain Med 2020; 21: 1636-43.
• Santeularia Vergés MT, Català Puigbò E, Genové Cortada M, Revuelta Rizo M, Moral García MV. Nuevas tendencias en el tratamiento del dolor postoperatorio en cirugía general y digestiva. Cir Esp 2009; 86: 63-71.
• Bigand T, Wilson M, Bindler R, Daratha K. Examining risk for persistent pain among adults with overweight status. Pain Manag Nurs 2018; 19: 549-56.
• Janke EA, Collins A, Kozak AT. Overview of the relationship between pain and obesity: What do we know? Where do we go next? J Rehabil Res Dev 2007; 44: 245-62.
• Wright LJ, Schur E, Noonan C, Ahumada S, Buchwald D, Afari N. Chronic pain, overweight, and obesity: findings from a community-based twin registry. J Pain 2010; 11: 628-35.
• Hartwig M, Allvin R, Bäckström R, Stenberg E. Factors associated with increased experience of postoperative pain after laparoscopic gastric bypass surgery. Obes Surg 2017; 27: 1854-58.
• Torres K, Szukała M, Torres A, Pietrzyk Ł, Maciejewski R. Assessment of the correlation between gender, age, body mass index and the severity of postoperative pain, nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Pol Merkur Lekarski 2015; 39: 9-13.
• Taivainen T, Tuominen M, Rosenberg PH. Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace. Br J Anaesth 1990; 64: 542-6.
• Hood DD, Dewan DM. Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology 1993; 79: 1210-8.
• Saryazdi HHG, Khalili G, Talakoub R, Shahbazi M, Abbasi S. Distribution of bupivacaine in epidural space. J Cell Mol Anesth 2018; 3: 60–5.
• Lee I, Yamagishi N, Oboshi K, Yamada H. Distribution of new methylene blue injected into the lumbosacral epidural space in cats. Vet Anaesth Analg 2004; 31: 190-4.
• Lee I, Yamagishi N, Oboshi K, Yamada H. Eliminating the effect of epidural fat during dorsolumbar epidural analgesia in cattle. Vet Anaesth Analg 2004; 31: 86-9.
• Gorgi AA, Hofmeister EH, Higginbotham MJ, Kent M. Effect of body position on cranial migration of epidurally injected methylene blue in recumbent dogs. Am J Vet Res 2006; 67: 219-21.
• Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am 2015; 95: 301-18.
• Imani F. Postoperative pain management. Anesth Pain Med 2011; 1: 6-7.
• Ülger G, Baldemir R, Zengin M, Sazak H, Alagöz A. Is there a correlation between preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios and postoperative pain in video-assisted thoracoscopic surgery? Medicine (Baltimore) 2022; 101: e29472.
• Canbolat N, Buget MI, Sivrikoz N, Altun D, Kucukay S. Relação entre a proporção neutrófilo/linfócito e a dor pós‐operatória em artroplastia total de joelho e quadril. Braz J Anesthesiol 2019; 69: 42-7.
• Akter N, Ratnayake B, Joh DB, Chan SJ, Bonner E, Pandanaboyana S. Postoperative pain relief after pancreatic resection: systematic review and meta-analysis of analgesic modalities. World J Surg 2021; 45: 3165-73.
• Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016; 17: 131-57.
• Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol 2016; 33: 160-71.
• Gao W, Yang XL, Hu JC, et al. Continuous serratus anterior plane block improved early pulmonary function after lung cancer surgical procedure. Ann Thorac Surg 2022; 113: 436-43.
• Bavullu EN, Aksoy E, Abdullayev R, Göğüş N, Dede D. Comparison of dexmedetomidine and midazolam in sedation for percutaneous drainage of hepatic hydatid cysts. Turk J Anaesthesiol Reanim 2013; 41: 195-9.
• Zengin EN. Research trends and global productivity on mechanical ventilation with the impact of COVID-19: a bibliometric analysis in the period 1980-2021. J Health Sci Med 2022; 5: 1051-61.
• Kalkman JC, Visser K, Moen J, Bonsel JG, Grobbee ED, Moons MKG. Preoperative prediction of severe postoperative pain. Pain 2003; 105: 415-23.
• Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618-25.
• Zengin M, Ulger G, Baldemir R, Sazak H, Alagoz A. Is there a relationship between body mass index and postoperative pain scores in thoracotomy patients with thoracic epidural analgesia? Medicine (Baltimore) 2021; 100: e28010.
• Yen CR, Tsou MY, Mandell MS, et al. An analysis of patient variables that influence intravenous patient-controlled analgesic use of morphine with quantile regression. Anesthesiology 2010; 112: 688-95.
• Lloret-Linares C, Lopes A, Declèves X, et al. Challenges in the optimisation of post-operative pain management with opioids in obese patients: a literature review. Obes Surg 2013; 23: 1458-75.
• Grodofsky SR, Sinha AC. The association of gender and body mass index with postoperative pain scores when undergoing ankle fracture surgery. J Anaesthesiol Clin Pharmacol 2014; 30: 248-52.
• Oliveira RR, Nascimento SL, Amaral MTPd, Silva MPPe, Oliveira MMF. Influence of body mass index on the frequency of lymphedema and other complications after surgery for breast cancer. Fisioterapia e Pesquisa 2016; 23: 84–90.
• Ingrande J, Brodsky JB, Lemmens HJ. Regional anesthesia and obesity. Curr Opin Anaesthesiol 2009; 22: 683-6.
• Cotter JT, Nielsen KC, Guller U, et al. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery - an analysis of 9,342 blocks. Can J Anaesth 2004; 51: 810-6.
• Chantzi C, Saranteas T, Zogogiannis J, Alevizou N, Dimitriou V. Ultrasound examination of the sciatic nerve at the anterior thigh in obese patients. Acta Anaesthesiol Scand 2007; 51: 132.
• Schwemmer U, Papenfuss T, Greim C, Brederlau J, Roewer N. Ultrasound-guided interscalene brachial plexus anaesthesia: differences in success between patients of normal and excessive weight. Ultraschall Med 2006; 27: 245-50.
• Hogan QH. Lumbar epidural anatomy. A new look by cryomicrotome section. Anesthesiology 1991; 75: 767-75.