Opioid Consumption After Thoracotomy and Factors Affecting Postoperative Acute Pain

January 9, 2026 updated by: Ramazan Baldemir, Ankara Ataturk Sanatorium Training and Research Hospital

Analysis of Opioid Consumption After Thoracotomy and Factors Affecting Postoperative Acute Pain

Thoracic surgery operations constitute a significant portion of surgical procedures performed in hospitals. In the United States, more than 50,000 thoracic surgical procedures are performed annually, and more than 80% of these patients experience moderate to severe postoperative pain requiring opioid administration, which increases the risk of complications . It has also been reported that chronic pain develops in approximately 50% of patients after thoracic surgery .

Thoracic surgery is commonly associated with severe, multifactorial pain during the postoperative period and is among the surgical branches with a high risk of developing chronic pain Despite advances in understanding postoperative pain mechanisms and improvements in pain management, inadequate postoperative pain control remains an unresolved healthcare problem. Higher acute pain scores are associated with less effective ventilation and coughing, increased incidence of lower respiratory tract infections, and prolonged ICU and hospital stays .

In the management of acute postoperative pain after thoracic surgery, clinicians have sought alternatives to thoracic epidural analgesia to avoid its potential adverse effects. Truncal blocks such as thoracic paravertebral block, erector spinae plane block, and serratus anterior block have been used to reduce postoperative pain . Additionally, various other analgesic techniques such as patient-controlled analgesia (PCA) and multimodal analgesia have been employed. Historically, the cornerstone of acute postoperative pain control has been systemic opioids administered via oral, intravenous, or thoracic epidural routes . Although opioids provide excellent pain relief, they are associated with significant side effects that can adversely affect recovery .

With the increasing use of ultrasonography (USG), truncal blocks have become more widespread. Alongside the development of Enhanced Recovery After Thoracic Surgery (ERATS) protocols, efforts have been made to reduce opioid use, leading to differing opinions regarding the management of acute pain after thoracic surgery. To prevent opioid use disorder and potential side effects, opioid-free or opioid-sparing approaches are now being encouraged in perioperative pain management . Conversely, some studies suggest that intraoperative opioid administration may have favorable effects on postoperative acute and chronic pain. Previous research has reported that the average daily opioid consumption after thoracic surgery is approximately 30 morphine milligram equivalents (MME) .

Although video-assisted thoracoscopic surgery (VATS) has become more common, thoracotomy cases still constitute a large proportion of thoracic surgery procedures. Moreover, severe postoperative pain after thoracic surgery is most commonly associated with the thoracotomy incision itself. While some studies have suggested that new truncal block techniques may provide effective analgesia and reduce opioid consumption after thoracotomy, further studies are needed to determine which blocks are most commonly preferred and how opioid consumption patterns have changed with the adoption of these newer regional techniques.

A review of the current literature reveals that the factors influencing acute pain after thoracotomy have not been sufficiently evaluated. Therefore, a re-evaluation of the factors affecting acute pain following thoracotomy, considering recent developments in pain management, is necessary. Furthermore, examining the relationship between perioperative opioid consumption, postoperative complications, and hospital length of stay in this patient population will provide valuable contributions to the literature.

The aim of this study is to evaluate the amount of opioid consumption following thoracotomy and to investigate whether perioperative opioid use affects acute pain, postoperative complications, and the length of hospital stay.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

H₀ (Null Hypothesis):

Opioid consumption in patients after thoracotomy is not high (≤30 morphine milligram equivalents [MME]/day).

H₁ (Alternative Hypothesis):

Opioid consumption in patients after thoracotomy is high (>30 morphine milligram equivalents [MME]/day).

Study Type

Observational

Enrollment (Estimated)

35

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Turkey (Türkiye)
      • Ankara, Turkey (Türkiye)
        • Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, 06280

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

This study will begin prospectively and will be completed once the targeted number of patients has been reached. The study population will consist of patients over 18 years of age who are scheduled to undergo thoracotomy under general anesthesia at the operating rooms of the Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital.

Description

Inclusion Criteria:

  • Patients aged over 18 years
  • Patients scheduled for thoracotomy
  • Patients with an American Society of Anesthesiologists (ASA) physical status classification of I-III
  • Patients who have provided informed consent
  • Patients with a body mass index (BMI) between 18-40 kg/m²

Exclusion Criteria:

  • Patients with ASA class IV or higher
  • Patients younger than 18 years old
  • Patients with systemic inflammatory disease
  • Patients receiving continuous anti-inflammatory and/or analgesic medication
  • Patients with chronic preoperative pain
  • Pregnant patients
  • Outpatients who received anesthesia outside the operating room
  • Emergency cases
  • Patients who underwent VATS, sternotomy, mediastinoscopy, or tracheal resection
  • Patients with a history of previous thoracic surgery
  • Patients who had a thoracic epidural catheter inserted for postoperative pain management
  • Patients with a BMI <18 or >40 kg/m²

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Patients aged over 18 years old scheduled for thoracotomy
The total intraoperative and postoperative opioid consumption will be determined. The effect of perioperative opioid use on postoperative acute pain, postoperative complications, and length of hospital stay will be investigated.
Other: Opioid Analgesic
The total intraoperative and postoperative opioid consumption will be determined. The effect of perioperative opioid use on postoperative acute pain, postoperative complications, and length of hospital stay will be investigated.
Other: Pain Medicine
Pain levels of patients at 1, 2, 4, 8, 16, 24, and 48 hours after thoracotomy will be evaluated using the Visual Analog Scale (VAS).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
opioid consumption
Time Frame: intraoperatively and for 24 hours postoperatively
intraoperatively and for 24 hours postoperatively
Determination of the amount of opioid consumption after thoracotomy
Time Frame: 24 hours
24 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ankara Ataturk Sanatorium Training and Research Hospital

Investigators

  • Principal Investigator: ZİYA CAN KUŞ, Ankara Ataturk Sanatorium Training and Research Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

January 5, 2026

Primary Completion (Estimated)

April 6, 2026

Study Completion (Estimated)

May 5, 2026

Study Registration Dates

First Submitted

December 29, 2025

First Submitted That Met QC Criteria

December 29, 2025

First Posted (Estimated)

January 9, 2026

Study Record Updates

Last Update Posted (Estimated)

January 12, 2026

Last Update Submitted That Met QC Criteria

January 9, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2024-KAEK-24/23

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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