Reply by the Authors of the Original Article

Comment on: “Continuous Analgesia with Intercostal Catheterization under the Thoracoscopy”

Our study strictly followed the qualification process of randomized controlled trials, with clear inclusion and exclusion criteria in the text, and ultimately obtained 80 eligible patients. In the research design, the sample size evaluation was also professionally analyzed. In our study, the sample size of each group of 40 patients was completely sufficient. The reference you provided clearly states that out of the 71 randomized controlled trials it included, the vast majority of the studies were conducted in abdominal, orthopaedic, and dental surgeries.[1] How can the pain research results of abdominal, plastic, and dental surgeries be generalized to those of thoracic surgeries?

The state of the patient when evaluated was of course consistent and was observed in a resting state.

The use of opioid intravenous analgesia pumps is the basic analgesic method for most postoperative patients in thoracic surgery in Shanghai and throughout China. This is also ethical. We have already described it in our article: “Thoracic surgery patients tend to suffer more severe postoperative pain than general surgery patients.”[2] The effectiveness of post-thoracotomy analgesia directly affects the incidence of postoperative pulmonary infections and whether patients can actively cough and expectorate after surgery. If you wait until the nonopioid analgesics are not effective and then use opioid drugs as rescue analgesia, the patient may have already developed a postoperative pulmonary infection.

If the analgesic intensity of morphine is 1, then the analgesic intensity of sufentanil is 1,000. However, there is no evidence of mutual conversion in terms of medication dosage. For example, 7.4 μg of intravenous sufentanil cannot simply be converted to 7.4 mg of intravenous morphine. If this is just an estimate, it is not enough to explain the problem. Furthermore, 7.4 μg is not an absolute intergroup difference, how can it be discussed separately? In addition, you have again cited literature that is mainly focused on abdominal, orthopaedic, and dental surgeries,[1] but not thoracic surgeries.

Our research mainly focuses on the short-term acute pain score of patients within 48 hours after surgery. The other indicators you described, such as the time to first ambulation, preservation of lung function, quality of postoperative recovery, length of hospital stay, readmission rate, and others, are relatively long-term observation indicators. How can lung function tests be performed when the drainage tube has not been removed and the patient is in acute pain? The quality of postoperative recovery can be observed only after several weeks or even several months. There are many other influencing factors for the length of hospital stay and readmission rates, such as postoperative lung leakage, etc., which are not necessarily related to the acute pain after surgery.

Publication History

Article published online:
12 February 2024

• References

• 1 Doleman B, Leonardi-Bee J, Heinink TP. et al. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev 2021; 6 (06) CD012978
• 2 Wang Y, Sun Q, Huang Y. et al. Continuous analgesia with intercostal catheterization after thoracoscopy. Thorac Cardiovasc Surg 2023; (e-pub ahead of print) DOI: 10.1055/a-2168-9081.