Different titration protocols in pain management after radical gastrectomy for gastric cancer patients

Table 1 Demographic and baseline characteristics of study participants, n (%)

Characteristic	12-hour titration regimen, n = 52	24-hour titration regimen, n = 68	P value
Age, years	58.3 ± 5.2	58.5 ± 5.4	0.84
Gender, male/female	33/27	32/28	0.85
BMI, kg/m²	24.7 ± 3.1	24.7 ± 3.0	0.92
Hypertension	19 (32)	20 (33)	0.89
Diabetes mellitus	11 (18)	10 (17)	0.81
Cardiovascular disease	8 (13)	9 (15)	0.74
Chronic pulmonary disease	7 (12)	8 (13)	0.83
Smoking history	23 (38)	24 (40)	0.82
Family history of CRC	13 (22)	14 (23)	0.88
Previous cancer history	7 (12)	8 (13)	0.87
Nutritional risk screening 2002	15 (16)	20 (18)	0.68
Preoperative anemia	5 (5)	8 (7)	0.62
Frailty assessment, positive	4 (4)	7 (6)	0.71
Preoperative anxiety, SAS score	45.2 ± 6.3	47.1 ± 7.0	0.23
Preoperative depression, SDS score	42.5 ± 5.8	44.3 ± 6.5	0.31
Preoperative hemoglobin, g/L	135 ± 10	134 ± 11	0.78

CRC: Colorectal cancer; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 2 Comparison of postoperative pain management regimens, %

Outcome measure	12-hour titration regimen, n = 52	24-hour titration regimen, n = 68	P value
VAS score at 12 hours postoperatively	3.2	4.8	< 0.001
Rescue analgesic doses in first 24 hours	1.2	2.1	0.005
Time to first analgesic request, hours	3.5	2.1	0.003
Time to independent ambulation, hours	18.5	24.2	0.008
Pulmonary complications	4.8	11.2	0.031
Postoperative ileus incidence	7.7	16.2	0.042
Time to first flatus, hours	38.4	46.7	0.012
Time to initiation of oral nutrition, days	2.3	3.1	0.009
Compliance with early rehabilitation protocols	85.6	67.3	0.004

VAS: Visual Analog Scale.

Table 3 Comparison of postoperative pain management at 24 hours, %

Outcome measure	12-hour group	24-hour group	P value
Total analgesic consumption, mg morphine equivalents	30	42	< 0.001
Adverse events
Postoperative nausea and vomiting	15	30	0.02
Respiratory depression	2	8	0.04
Constipation	18.2	32.4	0.016
Urinary retention	11.5	22.1	0.027
Hemodynamic stability
Hypotension requiring intervention	7.7	16.2	0.031
Bradycardia events	3.8	10.3	0.042
Sedation score, mean, 4-point scale	1.3	2.1	0.008
Immune function and inflammatory response
Postoperative cortisol levels, nmol/L	352 ± 87	425 ± 102	0.039
Interleukin-6 inflammatory response, pg/mL	42.3 ± 12.5	57.8 ± 15.4	0.028
Infectious outcomes
Surgical site infections	5.8	13.2	0.029
Overall infectious complications	9.6	19.1	0.018

Table 4 Comparison of analgesic consumption and pain management

Characteristic	12-hour titration regimen, n = 52	24-hour titration regimen, n = 68	P value
Total analgesic consumption, mg	30 ± 5.2	42 ± 6.8	< 0.001
Cox regression analysis: Hazard ratio	0.65	1.00	< 0.001
Number of rescue analgesic doses in first 24 hours	1.2	2.1	0.005
Patient satisfaction score, 0-10	8.5	7.2	0.001
Time to first analgesic request, hours	3.5	2.1	0.003
Incidence of adverse events, %	15.4	22.1	0.045
Length of hospital stay, days	4.2	4.8	0.020
Pain intensity at 48 hours postoperatively (VAS)	2.1	2.9	0.015
Pain intensity at 72 hours postoperatively (VAS)	1.8	2.5	0.030

VAS: Visual Analog Scale.

Table 5 Comparison of adverse reactions, %

Characteristic	12-hour titration regimen, n = 52	24-hour titration regimen, n = 68	P value
Incidence of postoperative nausea and vomiting	15	30	0.02
Incidence of respiratory depression	2	8	0.04
Cox regression analysis: Hazard ratio	0.45	1.00	< 0.001
Number of rescue analgesic doses in first 24 hours	1.2	2.1	0.005
Patient satisfaction score, 0-10	8.5	7.2	0.001
Time to first analgesic request, hours	3.5	2.1	0.003
Incidence of dizziness	5	10	0.03
Incidence of sedation	10	18	0.01
Length of hospital stay, days	4.2	4.8	0.020
Pain intensity at 48 hours postoperatively (VAS)	2.1	2.9	0.015
Pain intensity at 72 hours postoperatively (VAS)	1.8	2.5	0.030

VAS: Visual Analog Scale.

Table 6 Comparison of patient satisfaction, %

Characteristic	12-hour titration regimen, n = 52	24-hour titration regimen, n = 68	P value
Proportion of patients reporting “very satisfied” or “satisfied”	85	65	< 0.001
Cox regression analysis: Hazard ratio	0.40	1.00	< 0.001
Incidence of postoperative nausea and vomiting	15	30	0.02
Incidence of respiratory depression	2	8	0.04
Number of rescue analgesic doses in first 24 hours	1.2	2.1	0.005
Patient satisfaction score, 0-10	8.5	7.2	0.001
Time to first analgesic request, hours	3.5	2.1	0.003
Incidence of dizziness	5	10	0.03
Incidence of sedation	10	18	0.01
Length of hospital stay, days	4.2	4.8	0.020
Pain intensity at 48 hours postoperatively (VAS)	2.1	2.9	0.015
Pain intensity at 72 hours postoperatively (VAS)	1.8	2.5	0.030

VAS: Visual Analog Scale.