Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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/
Corresponding author: Xiao-Guang Zhang, MD, Doctor, Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. zhang.xiaoguang@zs-hospital.sh.cn
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
Processing time: 208 Days and 3.4 Hours
Abstract
BACKGROUND

Peroral endoscopic myotomy (POEM) is a safe and effective endoscopic treatment for achalasia. However, postoperative pain management for these patients is often neglected by anesthesiologists because of the short operative time, short hospital stay and the minimally invasive nature of the procedure.

AIM

To assess the pain and sleep quality of achalasia patients receiving the POEM procedure and investigate factors that affect postoperative pain.

METHODS

This observational study included patients with achalasia who underwent POEM at Zhongshan Hospital from December 2017 to March 2018. General anesthesia was performed with endotracheal intubation. The postoperative visual analog scale (VAS), postoperative sleep quality, basic patient information, and surgical parameters were collected. Depending on whether the 12-h post-POEM VAS score was less than 4, patients were divided into two groups, a well-controlled pain group and a poorly controlled pain group. Univariate, multivariate, and stepwise logistic regression analyses were used to investigate risk factors for poor pain control. A prediction model of post-POEM pain risk was established in the form of a nomogram. The calibration curve and receiver operating characteristic curve were used to evaluate the clinical usage of the prediction model. Repeated measures analysis of variance and simple effect analysis were used to verify whether differences in the VAS and sleep scores of the high- and low-risk groups, divided by the model from the raw data, were statistically significant.

RESULTS

A total of 45 eligible patients were included. Multivariate logistic regression and further stepwise logistic regression analysis found that 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. Repeated measures analysis of variance demonstrated that VAS (P = 0.0097) and sleep scores (P = 0.043) were higher in the high-risk group, and the interactions between the two main effects were obvious (VAS score: P = 0.019, sleep score: P = 0.035). Further simple effect analysis found that VAS scores were higher in the high-risk group at 2 h, 6 h and 12 h (P = 0.005, P = 0.019, P < 0.001), and sleep scores were higher in the high-risk group at day 1 (P = 0.006).

CONCLUSION

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.

Keywords: Achalasia; Peroral endoscopic myotomy; Anesthesia; Postoperative pain; Sleep quality; Nomogram

Core Tip: Post-peroral endoscopic myotomy (POEM) pain management has been neglected by anesthesiologists and endoscopists. In the present study, we found that achalasia patients experienced moderate to severe postoperative pain after the POEM procedure. The preoperative Eckardt score, previous treatment, and a longer distance between the muscle incision ending and the cardia were high risk factors for postoperative pain.