Changes in analgesic strategies for lobectomy from 2009 to 2018


Objective: To evaluate trends in the use of epidural analgesia and nonopioid and opioid analgesics for patients undergoing lobectomy from 2009 to 2018. Methods: We queried the Premier database for adult patients undergoing open, video-assisted, and robotic-assisted lobectomy from 2009 to 2018. The outcome of interest was changes in the receipt of epidural analgesia and nonopioid and opioid analgesics as measured by charges on the day of surgery. We also evaluated postoperative daily opioid use. We used multivariable logistic and linear regression models to examine the association between the utilization of each analgesic modality and year. Results: We identified 86,308 patients undergoing lobectomy from 2009 to 2018 within the Premier database: 35,818 (41.5%) patients had open lobectomy, 35,951 (41.7%) patients had video-assisted lobectomy, and 14,539 (16.8%) patients had robotic-assisted lobectomy. For all 3 surgical cohorts, epidural analgesia use decreased, and nonopioid analgesics use increased over time, except for intravenous nonsteroidal anti-inflammatory drugs. Use of patient-controlled analgesia decreased, while opioid consumption on the day of surgery increased and postoperative opioid consumption did not decrease over time. Conclusions: In this large sample of patients undergoing lobectomy, utilization of epidural analgesia declined and use of nonopioid analgesics increased. Despite these changes, opioid consumption on day of surgery increased, and there was no significant reduction in postoperative opioid consumption. Further research is warranted to examine the association of these changes with patient outcomes.






Published Version (Please cite this version)


Publication Info

Lo, Theresa, Robin Schiller, Karthik Raghunathan, Vijay Krishnamoorthy, Oliver K Jawitz, Srinivas Pyati, Thomas Van De Ven, Raquel R Bartz, et al. (2021). Changes in analgesic strategies for lobectomy from 2009 to 2018. JTCVS Open, 6. pp. 224–236. 10.1016/j.xjon.2021.03.015 Retrieved from

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Karthik Raghunathan

Associate Professor of Anesthesiology

Dr. Karthik Raghunathan is an Associate Professor with Tenure in the Department of Anesthesiology, with a secondary appointment in the Department of Population Health Sciences, at the Duke University School of Medicine and is a Staff Physician at the Durham Veterans Affairs Healthcare System. He is co-director of the Critical care And Perioperative population hEalth Research (CAPER) Program. 

In addition to clinical practice as an anesthesiologist and intensive care physician, Dr. Raghunathan is an epidemiologist and health services researcher with over $2 Million in funding from Federal, Industry, and Non-Profit entities since 2015. He co-directs the Critical care and Perioperative Population Health Research (CAPER) program, generating and disseminating evidence to inform clinical practice guidelines.

His studies focus on: a) the comparative effectiveness and safety of procedures and medications used for acute postoperative pain management, fluid resuscitation during surgery and intensive care; b) the implementation and effectiveness of nonpharmacologic treatments, such as music medicine and peripheral neuromodulation, and c) reducing race, sex, and income-based inequities in treatments and outcomes.

Dr. Raghunathan collaborates with colleagues within Duke, as well as colleagues at Academically affiliated other VA Healthcare Systems. He welcomes collaboration and can be reached at 


Vijay Krishnamoorthy

Associate Professor of Anesthesiology

Oliver Jawitz

House Staff

Srinivas Pyati

Associate Professor of Anesthesiology
Van de Ven

Thomas John Van de Ven

Associate Professor of Anesthesiology

Annemarie Thompson

Professor of Anesthesiology

Tetsu Ohnuma

Assistant Professor in Anesthesiology

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