This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 16, 2022; 10(17): 5655-5666 Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5655
High Eckardt score and previous treatment were associated with poor postperoral endoscopic myotomy pain control: A retrospective study
Wan-Nan Chen, Yao-Lin Xu, Xiao-Guang Zhang
Wan-Nan Chen, Xiao-Guang Zhang, Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Yao-Lin Xu, Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
Author contributions: Chen WN and Xu YL contributed equally to this work; Chen WN designed the research; Chen WN and Zhang XG managed the clinical process; Xu YL collected clinical data; Chen WN and Xu YL wrote the manuscript; Zhang XG revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Zhongshan Hospital affiliated with Fudan University, No. B2018-004R.
Conflict-of-interest statement: There are no conflicts of interest related to this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at zhang.xiaoguang@zs-hospital.sh.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: November 13, 2021 Peer-review started: November 13, 2021 First decision: December 27, 2021 Revised: March 25, 2022 Accepted: April 4, 2022 Article in press: April 4, 2022 Published online: June 16, 2022
ARTICLE HIGHLIGHTS
Research background
Postoperative pain management for peroral endoscopic myotomy (POEM) is often neglected by anesthesiologists because of the short operative time, short hospital stay and the minimally invasive nature of the procedure.
Research motivation
The authors conducted this retrospective study to examine the postoperative pain intensity of achalasia patients receiving the POEM procedure and to investigate possible risk factors for postoperative pain.
Research objectives
To achieve better postoperative pain management.
Research methods
We included patients with achalasia who underwent POEM at Zhongshan Hospital from December 2017 to March 2018. The postoperative visual analog scale, postoperative sleep quality, basic patient information, and surgical parameters were collected.
Research results
The preoperative Eckardt score [odds ratio (OR): 1.82, 95% confidence interval (CI): 1.17-2.84, P < 0.001], previous treatment (OR: 7.59, 95%CI: 1.12-51.23, P = 0.037) and the distance between the end of the muscle incision and the cardia (OR: 1.52, 95%CI: 0.79-293.93, P = 0.072) were risk factors for post-POEM pain.
Research conclusions
Achalasia patients who underwent POEM experienced serious postoperative pain, which may affect sleep quality. A higher Eckardt score, previous treatment, and a longer distance between the muscle incision ending and the cardia were risk factors for poor post-POEM pain control.
Research perspectives
We will further explore the optimal approach to postoperative analgesia in patients who underwent POEM surgery in the randomized controlled trial study and will cooperate with endoscopists to explore the effect of the POEM modus operandi (intrapleural tunnel length and myotomy position) on postoperative pain.
