Optimization of postoperative pain management in gynecological laparoscopic surgery with combined Nalbuphine and Remifentanil: A retrospective analysis with propensity score matching

Postoperative pain management is a critical aspect of perioperative care for patients undergoing gynecological laparoscopic surgery. The efficacy of different drug combinations in alleviating postoperative pain varies. Investigating the effects of Nalbuphine, Remifentanil, and their combination on postoperative pain can help optimize anesthesia protocols for these patients. This retrospective study analyzed data from 840 patients who underwent gynecological laparoscopic surgery, divided into a Nalbuphine group (n = 184), a Remifentanil group (n = 456), and a Nalbuphine-Remifentanil combination group (n = 200). Baseline and intraoperative data were collected. Patients were divided into 2 groups based on their 6-hour postoperative visual analog scale (VAS) score (VAS ≥ 5 and VAS < 5). A univariate logistic regression analysis was conducted on the selected factors and drug groups, followed by the construction of 3 multivariate logistic regression models. Model 1 included the selected factors, Model 2 added the drug groups, and Model 3 applied propensity score matching (PSM) based on Model 2. The area under the curve (AUC) of the receiver operating characteristic curve was used to assess the performance of the 3 models. Univariate logistic regression analysis indicated that surgical type, American Society of Anesthesiologists Physical Status Classification System (ASA) score, respiratory rate, and drug group were significantly associated with postoperative pain. Model 1 showed that ASA score, respiratory rate, and surgical type were independent factors for postoperative pain. Model 2, which included the drug groups, identified ASA score, surgical type, and drug groups (combination therapy vs single therapy) as independent factors for postoperative pain. In Model 3, after PSM, ASA score, surgical type, and drug groups remained significant independent factors. Receiver operating characteristic curve analysis demonstrated that Model 3 (AUC = 0.719) had better predictive performance than Model 2 (AUC = 0.674) and Model 1 (AUC = 0.659). This study showed that ASA score, surgical type, and drug group were key independent factors influencing postoperative pain in gynecological laparoscopic surgery patients. The combination of Nalbuphine and Remifentanil more effectively alleviated postoperative pain. Model 3, after PSM, exhibited improved predictive performance, suggesting a potential advantage of combination therapy in managing postoperative pain in these patients.