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Is Patient Controlled Analgesia Necessary After Robotic Thoracic Surgery?
Vijay Singh, Kavya Rao.
Zucker Hofstra School of Medicine, Bay Shore, NY, USA.

BACKGROUND: Postoperative pain after Robotic Thoracic surgery is a challenge to manage. The variability of one's ability to tolerate pain makes this topic an ongoing discussion. Patient controlled analgesia (PCA) is long considered to be optimal due to the ability for a patient to control administration. The waste of unused portions of anaesthesia and daily Anesthesiologist consultation can add significant cost to a patient's hospital stay. Therefore, we asked the question if PCA is necessary for the acute postoperative course.
METHODS: We randomized 20 patients undergoing lobectomy for stage I non small cell lung cancer. All patients had no previous thoracic surgical history. Five ports sites were used along the entire 8th intercostal space for the procedure. 30 milliliters of liposomal bupivicaine was administered between the 5th to 9th intercostal spaces at the conclusion of the procedure. 10 patients were managed with a timed regimen of oxycodone and morphine every three hours versus 10 patients were given a PCA. A numerical rating scale (1-10) was used to asses daily pain levels. Specifically, the number 1 being applicable to no pain versus a rating of 10 being given for severe pain. RESULTS: The mean length of stay was 3 days. Chest tubes were removed on average on post op day 1.5 for all patients. The mean pain scores dropped from 7 to 5 after removal of chest tube. There was no demonstrable difference in scores of either group. Depending on the length of stay, the PCA group averaged a cost of $400 more for the hospital stay.
CONCLUSIONS: We conclude the the use of PCA does not provide a significant impact in a patient's pain control, but can add significant cost and waste of medication. The lack of PCA but a strong pain regimen is non inferior and more economical after a robotic assisted lobectomy.

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