Analgesia and Pain in Female and Male Patients After Video-Assisted Thoracic Surgery: A Study Under Real-World Conditions

TL;DR

This study found that female patients after chest surgery needed more pain medication, but this was only fully addressed by all-female medical teams.

Contribution

The study reveals sex differences in opioid administration and team composition effects in real-world thoracic surgery settings.

Findings

Female patients had higher median piritramide demand than male patients, though not statistically significant.

All-female anaesthesia teams administered more opioids to female patients compared to mixed or all-male teams.

Pain scores and regional anaesthesia were similar between female and male patients.

Abstract

Background: Mounting evidence suggests that medical management may differ significantly between female and male patients. Despite studies showing increased sensitivity to pain, female patients receive less opioid analgesia compared to male patients after surgery. It is uncertain whether perioperative multimodal analgesia differs between sexes in thoracic surgery. Methods: A retrospective cohort study from January to July 2023 comparing multimodal analgesia and perceived pain in the early postoperative period between female and male patients after video-assisted thoracic surgery (VATS). The primary endpoint was the opioid demand in the post-anaesthesia care unit (PACU). Secondary outcomes included pain scores, regional anaesthesia and pain therapy by female, male or mixed teams. Results: Overall, 46.0% (n = 92) of the 200 included patients were female and 54% (n = 108) were male. Following VATS, the median piritramide demand was 9.0 [5.3 to 14.9] mg in female vs. 7.7 [4.5 to 12.9] mg in male patients (p = 0.35). Pain scores and regional anaesthesia were comparable between groups. In the early postoperative period, more opioids were administered overall and to female patients by all female anaesthesia teams, compared to mixed or all-male teams. Conclusions: The weight-adjusted dose of postoperative opioids did not differ between groups; neither did postoperative pain scores or the application of nerve blocks. The increased opioid demand in female patients was met by all female teams but not by all-male or mixed teams.

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