Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer

J Clin Anesth. 2014 Feb;26(1):3-17. doi: 10.1016/j.jclinane.2013.06.007. Epub 2013 Oct 4.

Abstract

Study objective: To determine whether postoperative epidural analgesia is associated with better recurrence-free survival and overall survival after lung cancer surgery.

Design: Retrospective study.

Setting: Academic hospital.

Measurements: Data of patients with stage 1, stage 2, and stage 3 nonsmall cell lung cancer, who underwent tumor resection surgery, were studied. Patient data were grouped into three different postoperative pain management interventions: intravenous patient-controlled analgesia, patient-controlled epidural analgesia, and their combination. Univariate and multicovariate Cox proportional hazards models were applied to assess the effects of covariates of interest on overall survival and recurrence-free survival.

Main results: The type of postoperative analgesia used for patients who underwent surgery for nonsmall cell lung cancer did not affect recurrence-free survival or overall survival. However, certain variables, including age ≥ 65 years, male gender, body mass index ≥ 25 kg/m(2), ASA physical status 4, and the need for preoperative blood transfusions, pneumonectomy, and postoperative radiation, were associated with decreased recurrence-free survival and overall survival.

Conclusions: The type of postoperative analgesia used after surgery for nonsmall cell lung cancer is not associated with better 2-year or 5-year recurrence-free survival or overall survival rates.

Keywords: Analgesia; Epidural; Intravenous; Nonsmall cell lung carcinoma; Patient-controlled; Postoperative.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Amides / pharmacology
  • Analgesia, Epidural / methods*
  • Analgesia, Patient-Controlled / methods
  • Analgesics, Opioid / pharmacology
  • Anesthetics, Local / pharmacology
  • Body Mass Index
  • Bupivacaine / pharmacology
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Drug Therapy, Combination / methods
  • Female
  • Fentanyl / pharmacology
  • Follow-Up Studies
  • Health Status
  • Humans
  • Hydromorphone / pharmacology
  • Lung / surgery
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / prevention & control*
  • Pain Management / methods
  • Pain, Postoperative / drug therapy*
  • Proportional Hazards Models
  • Retrospective Studies
  • Ropivacaine
  • Sex Factors
  • Survival Rate
  • Treatment Outcome

Substances

  • Amides
  • Analgesics, Opioid
  • Anesthetics, Local
  • Ropivacaine
  • Hydromorphone
  • Fentanyl
  • Bupivacaine