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Regional anesthesia and acute pain
Criteria for continuous neuraxial analgesia associated with reduced mortality in patients undergoing thoracotomy
  1. Axel Semmelmann1,
  2. Wolfgang Baar1,
  3. Isabelle Moneke2 and
  4. Torsten Loop1
  1. 1Department of Anesthesiology and Critical Care, Universitätsklinikum Freiburg, Freiburg, Germany
  2. 2Department of Thoracic Surgery, Medical Center - University of Freiburg, University of Freiburg Faculty of Medicine, Freiburg, Germany
  1. Correspondence to Dr Axel Semmelmann, Department of Anesthesiology and Critical Care, Universitätsklinikum Freiburg, Freiburg, Germany; axel.semmelmann{at}uniklinik-freiburg.de

Abstract

Introduction Both thoracic epidural analgesia and thoracic paravertebral analgesia are effective techniques to control pain and minimize the stress response following thoracic surgery. We hypothesized that continuous neuraxial techniques may be associated with a decrease in the incidence of postoperative mortality after thoracotomy. Additionally, we aimed to identify subgroup populations that may benefit more from neuraxial anesthesia.

Method 1620 patients who underwent open thoracotomy were included in this retrospective study from the German Thoracic Registry database at four university hospitals. All-cause inpatient mortality was determined for patients who had and did not have neuraxial anesthesia. Logistic regression was used to adjust for and explore various covariates.

Results Continuous neuraxial analgesia was associated with a lower overall mortality in the postoperative period (2.9%, 23/796 vs 5.3%, 44/824, p=0.02) only after the univariate analysis but not the multivariable analysis (OR 0.49, 95 % CI 0.237 to 1.12, p=0.15). In patients with epidural or paravertebral catheters, mortality was significantly lower in the following subgroups: age >75 (5/113 vs 18/77, OR 0.1, 95% CI 0.02 to 0.67, p=0.02), American Society of Anesthesiologists Performance Score >III (11//97 vs 33/155, OR 0.32, 95% CI 0.11 to 0.89, p=0.03), chronic kidney disease (5/83 vs 16/77, OR 0.16, 95% CI 0.03 to 0.82, p=0.03), and postoperative sepsis (9/21 vs 17/25, OR 0.13, 95% CI 0.07 to 0.44, p<0.01).

Conclusions Neuraxial analgesic techniques are associated with reductions in postoperative mortality after open thoracic surgery in selected patients.

  • analgesia
  • outcomes
  • pain management
  • pain, postoperative
  • anesthesia, local

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/rapm-2024-105537

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    Data availability statement

    Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Collaborators Not applicable.

    • Contributors Conception and design: AS and TL. Provision of study material, patient data: Working Group of the German Thoracic Registry Collection and assembly of data: IM and WB. Data analysis and interpretation: AS and TL. Manuscript writing: AS, TL, WB and IM. Overall guarantor: AS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.