P1.206. Pain Discordance Between Abdominal and Thoracic Sites After Oesophagectomy in a Multimodal Analgesia Pathway

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Pain after oesophagectomy arises from both abdominal and thoracic components, yet patients often report unequal site-specific pain. Quantifying abdominal–thoracic pain discordance may help tailor site-targeted analgesic strategies and clarify whether robotic access reduces clinically meaningful discordance. Methods A retrospective audit of consecutive oesophagectomy patients managed within a multimodal analgesia pathway. Abdominal and thoracic pain scores (0–10 NRS) recorded on postoperative days (POD) 1–5 were extracted; for each POD, the maximum recorded score at each site was used. Discordance was calculated as thoracic minus abdominal pain (paired by patient and POD) and summarised as thorax-dominant (>0), abdomen-dominant (<0), or equal. Large discordance was prespecified as an absolute inter-site difference >3 points. Differences in large discordance by thoracic access (open vs robotic) were analysed using a population-averaged logistic model (GEE) with clustering by patient and adjustment for POD. Results A total of 131 patients contributed 647 paired patient-days. Thoracic pain exceeded abdominal pain in 39.9% of observations, abdominal exceeded thoracic in 17.0%, and scores were equal in 43.1%. Large discordance (>3 points) occurred in 21.3% of patient-days. Large discordance was more frequent following open thoracic access than robotic thoracic access (25.1% vs 17.3%). In the adjusted GEE model, open thoracic access showed higher odds of large discordance (odds ratio 1.60, 95% CI 0.97–2.65; p=0.067). Conclusion Recognising patterns of discordance may support ongoing quality improvement by enabling more targeted analgesic strategies, particularly through refinement of regional anaesthesia techniques. Open thoracic access showed a trend toward greater ldiscordance compared with robotic access. Further work should focus on identifying predictors of discordance and examining associations with opioid consumptions, mobilisation, postoperative complications and length of stay.