To the Editor:
postoperative pain, pain
By a randomized, double-blinded, clinical trial of 119 patients undergoing thoracoscopic pulmonary resection, Li et al. [First, this study actually used an opioid-based multimodal analgesic strategy, i.e., patient controlled analgesia (PCA) with intravenous sufentanil. This does not meet the requirements of the standard opioid-sparing multimodal analgesic strategy recommended in the current Enhanced Recovery After Surgery (ERAS) protocols for thoracic surgery, in which other than a nerve or fascial plane block, a serial of non-opioid basic analgesics with different mechanisms, such as paracetamol, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 specific inhibitors, gabapentin, dexamethasone, are included in order to achieve adequate co-analgesia and decrease opioid consumption. Most important, it is required that application of these non-opioid analgesics should be started before or during operation and regularly repeated after surgery, and opioids should be administered as rescue analgesia only when non-opioid basic analgesics are ineffective or contraindicated [Second, parecoxib sodium was intravenously given for rescue analgesia when postoperative rest pain VAS score in the ward was > 3. Furthermore, the need of rescue analgesia during 48 h postoperatively was significantly decreased in the patients receiving the ICNB compared with control patients. In fact, parecoxib sodium only is a weak basic analgesic. As a main goal of ERAS programs is to minimize opioid use, it may be better to use parecoxib sodium as a rescue analgesic for moderate pain. However, opioids should still be standard rescue analgesics for inadequate postoperative pain control with non-opioid basic analgesic [Third, pain VAS score at each observed point within 48 h postoperatively was statistically significantly lower in the patients receiving the ICNB compared to the control patients. Other than 0 and 4 h postoperatively, however, means of pain VAS scores at other time points postoperatively were 3 or less, indicating that most patients in the two groups only experienced mild postoperative pain, which achieves postoperative pain control goal of ERAS programs for thoracic surgery [Finally, this study showed that duration of chest tube insertion, an outcome variable of the ERAS programs for thoracic surgery [