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Aim Respiratory complications arising from disrupted evacuation of bronchopulmonary secretions are frequently encountered following anatomical lung resections. In cases refractory to mucolytics and chest physiotherapy, definitive management usually entails bronchoscopic aspiration. Pain is an important precipitating factor for sputum retention impeding mucociliary clearance and productive cough. Opioids remain the mainstay of postoperative analgesia but can also promote retention of secretions due to their anti-tussive properties and ventilatory depression. In this study, we aimed to review the efficacy of oral opioids against patient-controlled analgesia (PCA) in immediate post-operative period. We further explored if use of PCA predisposed to post-operative bronchoscopy. Method A retrospective case note analysis was conducted for all 329 patients undergoing lung resections (lobectomy, wedge resection, segmentectomy, pneumonectomy, metastasectomy both via thoracotomy and VATS approach) between May 2016 and December 2019 in a Thoracic Surgery Unit under a single consultant surgeon. Results Of the 329 patients undergoing lung resections, 46.8% patients received oral opioids and remaining 53.1% received PCA for immediate postoperative pain management. Pain scores at rest were documented for 48.02% patients – scores calculated at 10.39+/-8.7 hours after completion of surgery were 1.023+/-0.754 for the PCA cohort and 0.904+/-0.756 for patients receiving oral opioids (p = 0.131). 13 patients were noted to undergo bronchoscopy to aid in secretion clearance. Univariate analysis failed to establish a correlation between use of PCA and incidence of post-operative bronchoscopy (p = 0.603). Conclusions PCA is not associated with significant sputum retention necessitating bronchoscopic aspiration. It, however, does not offer superior analgesia for static pain compared to oral opioids.

british journal of surgery

351 Oral Opioids vs Patient Controlled Analgesia: Efficacy of Analgesia Post Lung Resection and Association with Postoperative Bronchoscopy and Bronchial Aspiration – a Single Center Observational Retrospective Study