Opioid Consumption After Thoracotomy and Factors Affecting Postoperative Acute Pain

NCT ID: NCT07329855

Last Updated: 2026-01-12

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Total Enrollment: 35 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2026-01-05
• Study Completion Date: 2026-05-05

Brief Summary

Thoracic surgery operations constitute a significant portion of surgical procedures performed in hospitals. In the United States, more than 50,000 thoracic surgical procedures are performed annually, and more than 80% of these patients experience moderate to severe postoperative pain requiring opioid administration, which increases the risk of complications . It has also been reported that chronic pain develops in approximately 50% of patients after thoracic surgery .

Thoracic surgery is commonly associated with severe, multifactorial pain during the postoperative period and is among the surgical branches with a high risk of developing chronic pain Despite advances in understanding postoperative pain mechanisms and improvements in pain management, inadequate postoperative pain control remains an unresolved healthcare problem. Higher acute pain scores are associated with less effective ventilation and coughing, increased incidence of lower respiratory tract infections, and prolonged ICU and hospital stays .

In the management of acute postoperative pain after thoracic surgery, clinicians have sought alternatives to thoracic epidural analgesia to avoid its potential adverse effects. Truncal blocks such as thoracic paravertebral block, erector spinae plane block, and serratus anterior block have been used to reduce postoperative pain . Additionally, various other analgesic techniques such as patient-controlled analgesia (PCA) and multimodal analgesia have been employed. Historically, the cornerstone of acute postoperative pain control has been systemic opioids administered via oral, intravenous, or thoracic epidural routes . Although opioids provide excellent pain relief, they are associated with significant side effects that can adversely affect recovery .

With the increasing use of ultrasonography (USG), truncal blocks have become more widespread. Alongside the development of Enhanced Recovery After Thoracic Surgery (ERATS) protocols, efforts have been made to reduce opioid use, leading to differing opinions regarding the management of acute pain after thoracic surgery. To prevent opioid use disorder and potential side effects, opioid-free or opioid-sparing approaches are now being encouraged in perioperative pain management . Conversely, some studies suggest that intraoperative opioid administration may have favorable effects on postoperative acute and chronic pain. Previous research has reported that the average daily opioid consumption after thoracic surgery is approximately 30 morphine milligram equivalents (MME) .

Although video-assisted thoracoscopic surgery (VATS) has become more common, thoracotomy cases still constitute a large proportion of thoracic surgery procedures. Moreover, severe postoperative pain after thoracic surgery is most commonly associated with the thoracotomy incision itself. While some studies have suggested that new truncal block techniques may provide effective analgesia and reduce opioid consumption after thoracotomy, further studies are needed to determine which blocks are most commonly preferred and how opioid consumption patterns have changed with the adoption of these newer regional techniques.

A review of the current literature reveals that the factors influencing acute pain after thoracotomy have not been sufficiently evaluated. Therefore, a re-evaluation of the factors affecting acute pain following thoracotomy, considering recent developments in pain management, is necessary. Furthermore, examining the relationship between perioperative opioid consumption, postoperative complications, and hospital length of stay in this patient population will provide valuable contributions to the literature.

The aim of this study is to evaluate the amount of opioid consumption following thoracotomy and to investigate whether perioperative opioid use affects acute pain, postoperative complications, and the length of hospital stay.

Detailed Description

H₀ (Null Hypothesis):

Opioid consumption in patients after thoracotomy is not high (≤30 morphine milligram equivalents [MME]/day).

H₁ (Alternative Hypothesis):

Opioid consumption in patients after thoracotomy is high (>30 morphine milligram equivalents [MME]/day).

Conditions

Thoracic Anesthesia; Thoracotomy; Opioid; Postoperative Pain Management; Length of Hospital Stay

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Patients aged over 18 years old scheduled for thoracotomy

The total intraoperative and postoperative opioid consumption will be determined. The effect of perioperative opioid use on postoperative acute pain, postoperative complications, and length of hospital stay will be investigated.

Opioid Analgesic

Intervention Type: OTHER

The total intraoperative and postoperative opioid consumption will be determined. The effect of perioperative opioid use on postoperative acute pain, postoperative complications, and length of hospital stay will be investigated.

Pain Medicine

Intervention Type: OTHER

Pain levels of patients at 1, 2, 4, 8, 16, 24, and 48 hours after thoracotomy will be evaluated using the Visual Analog Scale (VAS).

Interventions

Opioid Analgesic

The total intraoperative and postoperative opioid consumption will be determined. The effect of perioperative opioid use on postoperative acute pain, postoperative complications, and length of hospital stay will be investigated.

Intervention Type: OTHER

Pain Medicine

Pain levels of patients at 1, 2, 4, 8, 16, 24, and 48 hours after thoracotomy will be evaluated using the Visual Analog Scale (VAS).

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patients aged over 18 years
• Patients scheduled for thoracotomy
• Patients with an American Society of Anesthesiologists (ASA) physical status classification of I-III
• Patients who have provided informed consent
• Patients with a body mass index (BMI) between 18-40 kg/m²

Exclusion Criteria

• Patients with ASA class IV or higher
• Patients younger than 18 years old
• Patients with systemic inflammatory disease
• Patients receiving continuous anti-inflammatory and/or analgesic medication
• Patients with chronic preoperative pain
• Pregnant patients
• Outpatients who received anesthesia outside the operating room
• Emergency cases
• Patients who underwent VATS, sternotomy, mediastinoscopy, or tracheal resection
• Patients with a history of previous thoracic surgery
• Patients who had a thoracic epidural catheter inserted for postoperative pain management
• Patients with a BMI <18 or >40 kg/m²

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ankara Ataturk Sanatorium Training and Research Hospital

OTHER_GOV

Sponsor Role: lead

Responsible Party

Ramazan Baldemir

Clinic Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

ZİYA CAN KUŞ

Role: PRINCIPAL_INVESTIGATOR

ANKARA ATATURK SANATORİUM TRAİNİNG AND RESEARCH HOSPITAL

Locations

Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, 06280

Ankara, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

Central Contacts

Ziya Can KUŞ

Role: CONTACT

ziyacankus2013@gmail.com

+905360725382

Other Identifiers

2024-KAEK-24/23

Identifier Type: -

Identifier Source: org_study_id