Patient preferences for analgesia in lung surgery: an observational cohort study

Background: Optimal analgesia following thoracoscopic lung surgery is crucial for patient comfort and effective recovery. Despite the lack of high quality evidence in guidelines, experts favour locoregional analgesic techniques above thoracic epidural analgesia (TEA), without considering patient preferences. This study investigates patient choices to aid in shared-decision making and incorporation in guidelines. Methods: Through adaptive conjoint analysis (ACA) concerning attributes (characteristics) related to analgesic techniques and treatment trade-off methods (TTM) comparing scenarios with locoregional analgesia against TEA, 200 patients planned for thoracoscopic lung resection in five Dutch hospitals received online questionnaires. In the TTM, patients were repeatedly asked to choose between two scenarios: one describing thoracic epidural analgesia with fixed low levels of pain and the other representing locoregional analgesia with varying pain levels, to assess trade-off thresholds. For the ACA, Relative Importance (RI) of the characteristics was calculated with 95%-confidence intervals (CI). Results: Response rates of ACA and TTM questionnaires were 72% (144/200) and 71% (141/200) respectively. The most important characteristics were state of consciousness (‘awake or under general anaesthesia’) while receiving the analgesic technique (RI 20.45; 95%-CI 19.12–21.75) and mobilisation (RI 19.42; 95%-CI 18.45–20.38). In the TTM, 10 patients (7.1%) consistently chose the TEA scenario, irrespective of the benefits of locoregional analgesia. In contrast, 131 patients (92.9%) preferred experiencing more moments of pain as trade-off for the potential advantages associated with locoregional analgesia. Conclusion: Regarding analgesia following thoracoscopic lung surgery, patients considered the state of consciousness while receiving the analgesic technique (awake or under general anaesthesia) and postoperative mobility as the most important characteristics. Over 92% of patients are willing to accept more moments of pain as trade-off for the potential benefits of locoregional analgesia. These findings are aligned with current guideline recommendations and support the inclusion of patient preferences in shared decision-making.