Reduced Use of Epidural Analgesia Linked to Earlier Discharge After Lung Resection

By David Douglas

November 28, 2019

NEW YORK (Reuters Health) - Reduced use of epidural analgesia has had no negative short-term effect on patients with non-small-cell lung cancer (NSCLC) undergoing minimally invasive surgery (MIS) lobectomy, researchers have found.

"The current study, using a large cohort of lung cancer patients who underwent surgery, shows that significant decrease in use of epidural analgesia did not affect outcomes," Dr. Prasad S. Adusumilli of Memorial Sloan Kettering Cancer Center, in New York City, told Reuters Health by email. "In fact, patients avoided an additional invasive procedure and were able to be discharged a day earlier."

At his institution, he explained, four out of five lung-cancer surgeries are now performed using minimally invasive procedures. This has meant a drop in the use of epidural analgesia, which was common earlier when thoracotomy was the dominant approach.

To examine what impact these changes may have had, Dr. Adusumilli and his colleagues analyzed data on close to 800 patients who underwent lobectomy for pathological stage I-III NSCLC without induction therapy in 2009 to 2010 and 2014 to 2015.

Between these two periods, the proportion of patients undergoing thoracotomy fell from 53% to 24%, and the use of EA dropped from 95% to 51% (P=0.001), the researchers report in Lung Cancer, online November 11.

There was no difference in postoperative morbidity and mortality in both the MIS and thoracotomy groups between the two time periods. A comparison of 150 patients who received EA following MIS lobectomy in the late-time period and 158 who didn't also showed no difference in morbidity and mortality.

Moreover, the no-EA group had a significantly shorter hospital stay (four vs. three days).

Although prospective research is warranted, the researchers write, "our study provides strong retrospective evidence that decreasing use of EA is not associated with increasing postoperative morbidity or inpatient stay. This data argues against the traditional thought process that calls for routine use of EA."


Lung Cancer 2019.