Abstract
BACKGROUND: Multimodal analgesia (MMA) combines different analgesic methods, such as non-steroidal inflammatory drugs (NSAIDs), acetaminophen, and regional anesthesia techniques, to optimize pain control while minimizing opioid use. Dinalbuphine sebacate (DS), a long-acting prodrug of nalbuphine, was chosen due to its potential to enhance MMA strategies. The aim of this study is to evaluate the effectiveness of DS in MMA for video-assisted thoracoscopic surgery (VATS). METHODS: Sixty participants were randomly and equally assigned to either the MMA regimen containing DS (DS group) or placebo (placebo group). After anesthesia induction, all participants received ultrasound-guided thoracic paravertebral block (TPVB), and DS or placebo was injected into the gluteus medius muscle on the operated side. Intravenous patient-controlled analgesia (IVPCA) with fentanyl was provided for breakthrough pain postoperatively. The primary outcome was postoperative fentanyl consumption over three days. Statistical tests included Student's t-test, chi-square test, and Fisher's exact test. RESULTS: Finally, 57 participants were assigned to either the DS group (n = 28) or the placebo group (n = 29). The mean fentanyl consumption over three days was significantly lower in the DS group (283 ± 70 µg) compared to the placebo group (708 ± 190 µg, P < 0.001). Pain interference with daily life was significantly lower in the DS group at one week (28.57% vs. 86.2%, P < 0.001) and one month postoperatively (10.71% vs. 48.28%, P = 0.003). Pain intensity during movement was significantly lower in the DS group at one week (2.07 ± 0.61 vs. 4.00 ± 0.56, P < 0.001) and one month (0.64 ± 0.35 vs. 2.10 ± 0.4, P < 0.001). CONCLUSIONS: By providing superior analgesia, reducing opioid requirements, improving functional recovery and its long-lasting effect after discharge, DS enhanced postoperative MMA for VATS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT04962152; Date: 14/07/2021.