Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia

Yanagimoto, Yoshitomo; Takiguchi, Shuji; Miyazaki, Yasuhiro; Mikami, Jota; Makino, Tomoki; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Yamasaki, Makoto; Miyata, Hiroshi; Nakajima, Kiyokazu; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s00595-015-1162-y

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…Firstly, in our study, the EGA group had lower VAS scores on the postoperative three days. The results were consistent with that of a recently study, it found epidural use was associate with less number of additional doses of analgesics, and provided better analgesic effect, [ 25 ] both the two studies found no difference in length of hospital stay between the epidural and non-epidural use groups. In our study, there were no differences in flatus time between the two groups, while in the above mentioned study, the first time of flatus was earlier in the epidural group.…”

Section: Discussionsupporting

confidence: 92%

The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study

Wang

Chen

et al. 2017

Oncotarget

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BackgroundEpidural use can provide a better short-term outcome and protect patients from the postoperative development of tumour recurrence and metastases. In this study, we sought to assess the effects of intra- and postoperative anaesthesia and analgesia choice on outcome after gastric cancer resection, searched for evidence of interaction between intra-and postoperative epidural use and outcomes of gastric cancer patients.MethodsFour thousand two hundred and eighteen cases of gastric cancer were identified from the Records of Hospital Patients. Patients who received only general anesthesia (GA group) or epidural anesthesia combined with general anesthesia (EGA group), were administered patient-controlled intravenous or epidural analgesia for 72-120 hours postoperatively. Flatus time, length of stay in hospital, incidence of nausea and vomiting, and visual analogue scale (VAS ) scores were collected for evaluating the short-outcome of the patients. A Kaplan-Meier log-rank test was used for a univariable analysis, and Cox proportional hazards regressions were used for a multivariable analysis of the survival time in both groups.ResultsThe VAS scores and incidence of nausea and vomiting in the EGA group were lower than the GA group. There was a significant association between intra-and postoperative epidural use and improved survival.ConclusionsThese results indicated that epidural anaesthesia combined with general anaesthesia and patient-controlled epidural analgesia may be associated with the improved overall survival in gastric cancer patients who underwent resection.

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Section: Discussionsupporting

confidence: 92%

The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study

Wang

Chen

et al. 2017

Oncotarget

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“…The incidence of PONV was higher in the GA group. It has been proven that epidural anaesthesia can provide better analgesia after gastric cancer surgery, which was consistent with our study [22]. Epidural administration of anaesthesia and analgesia is considered a technique with risk of complications, such as neuraxial haematoma, hypotension, pruritus; the subjective experience of anaesthetists often leads to the failure of epidural anaesthesia and analgesia [23, 24].…”

Section: Discussionsupporting

confidence: 89%

The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection

et al. 2019

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Background Epidural use can prevent peri-operative neuro-endocrine stress responses, mitigate pain after surgery, and reduce opioid use, which all lead to immunosuppression. Methods Forty patients with gastric cancer were ultimately enrolled into the study. Patients who received general anaesthesia (GA group, n = 20) or a combination of general anaesthesia and peri-operative epidural use (EGA group, n = 20) were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the time of the first passage of flatus and incidence of postoperative nausea and vomiting (PONV). We also collected data on the cluster of differentiation markers (CD) 3+ , CD 4+ , CD 8+ , CD 4+ /CD 8+ , interleukin (IL)-4, IL-6, and interferon (IFN)-γ the day before surgery as well as on postoperative days 1, 3, and 7. Results VAS scores and PONV in the GA group were higher than in the EGA group on postoperative day 3. CD 3+ , CD 4+ , and CD 4+ /CD 8+ T cells declined on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. CD 3+ T cells decreased more in the GA group than in the EGA group. IL-4, IL-6, and IFN-γ increased on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. IL-4 and IL-6 increased more in the GA group than in the EGA group. IFN-γ increased more in the EGA group than in the GA group. Conclusions A combination of general anaesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anaesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection. Trial registration The study procedures were approved by the Ethics Committee of The Harbin Medical University Cancer Hospital. This study was registered prospectively at http://www.chictr.org.cn/index.aspx on October 10, 2017 (Registered ChiCTR-INR-17012939 ).

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“…Additionally, some reports have shown that epidural postoperative analgesia could improve the outcome and survival after major surgery. 4 – 9 However, many other studies have shown that epidural analgesia has no relevant effect on the reduction of morbidity and mortality after major surgery. 10 – 13 Nonetheless, few previously mentioned studies have focused on the effect of PCEA in patients with GC.…”

Section: Introductionmentioning

confidence: 99%

Effect of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain management and short-term outcomes after gastric cancer resection: a retrospective analysis of 3,042 consecutive patients between 2010 and 2015

Wang¹,

Li²,

Chen³

et al. 2018

JPR

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BackgroundEffective postoperative analgesia is essential for rehabilitation after surgery. Many studies have compared different methods of postoperative pain management for open abdominal surgery. However, the conclusions were inconsistent and controversial. In addition, few studies have focused on gastric cancer (GC) resection. This study aimed to determine the effects of patient-controlled epidural analgesia (PCEA) on postoperative pain management and short-term recovery after GC resection compared with those of patient-controlled intravenous analgesia (PCIA).MethodsWe analyzed retrospectively collected data on patients with non-metastatic GC diagnosed between 2010 and 2015 who underwent resection in a university hospital. PCIA and PCEA documented by the acute pain service team were retrospectively analyzed. A propensity score-matched analysis that incorporated preoperative variables was used to compare the short-term outcomes between the PCIA and PCEA groups.ResultsIn total, 3,042 patients were identified for analysis. Propensity score matching resulted in 917 patients in each group. The PCEA group exhibited lower pain scores in the recovery room and on the first and second postoperative days (P=0.0005, P=0.0065, and P=0.0034 respectively). The time to the first passage of flatus after surgery was shorter in the PCEA group than in the PCIA group (P=0.032). The length of the hospital stay was 12.6±7.2 and 11.8±6.6 days in the PCEA and PCIA groups, respectively. No significant differences were observed in the length of hospital stay or the incidence of complications after surgery.ConclusionPCEA provided more effective postoperative pain management and a shorter time to the first passage of flatus than PCIA after GC resection. However, it did not have an effect on the length of hospital stay or the incidence of postoperative complications.

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Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia

Abstract: Epidural anesthesia may reduce the need for additional analgesics after LDG, but increases the risk of urinary retention.

Cited by 14 publications

References 28 publications

The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study

The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study

The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection

Effect of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain management and short-term outcomes after gastric cancer resection: a retrospective analysis of 3,042 consecutive patients between 2010 and 2015

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