Effect of epidural analgesia on postoperative complications following pancreaticoduodenectomy

Amini, Albert; Patanwala, Asad E.; Maegawa, Felipe B.; Skrepnek, Grant H.; Jie, Tun; Gruessner, Rainer W.G.; Ong, Evan

doi:10.1016/j.amjsurg.2012.05.022

Cited by 38 publications

(49 citation statements)

References 16 publications

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“…In the propensity-matched cohort, the use of epidural analgesia was not associated with diff erences in the incidence of postoperative respiratory complications (respiratory failure, pneumonia, atelectasis), cardiac complications or myocardial infarction, thrombotic events, acute renal failure, ileus, sepsis, or urinary complications (Table 4). Finally, the length of hospital stay (median, [interquartile range]) was 6 [5][6][7][8] days vs 6 [4][5][6][7][8] days for patients with and without epidurals, respectively. …”

Section: Methodsmentioning

confidence: 99%

“…In addition, hospital length of stay was compared between the groups. All the endpoints were selected a priori based on current literature on use of epidural analgesia for major abdominal surgery (5,7,22,23). In-hospital death was determined directly from a variable present in the database.…”

Section: Methodsmentioning

confidence: 99%

“…A matched cohort of 802 patients per group was derived from the propensity-matching algorithm. Although use of EA was associated with more blood transfusions (relative risk, 1.36; 95% confidence interval, 1.12-1.65; P = 0.001) and longer hospital stay (median [interquartile range], 6 [5][6][7][8] vs 6 [4][5][6][7][8] days), the use of coagulation factors and the incidence of postoperative hemorrhage/hematomas or other postoperative complications were not higher in patients receiving EA. In conclusion, the use of EA for MLR is low, and EA does not seem to influence the incidence of postoperative complications.…”

mentioning

confidence: 99%

“…Inadequate pain management can lead to increased postoperative morbidity and delayed recovery (4). Epidural analgesia has been shown to provide excellent dynamic pain relief as well as improve postoperative pulmonary, cardiovascular, and gastrointestinal function (2,(5)(6)(7)(8)(9). Epidural analgesia can enhance rehabilitation and reduce hospital length of stay after major abdominal surgical procedures, presumably due to superior pain relief as well as reduced opioid use and reduced opioid-related adverse eff ects (10,11).…”

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confidence: 99%

See 3 more Smart Citations

Evaluation of Epidural Analgesia for Open Major Liver Resection Surgery from a us Inpatient Sample

Rosero

Cheng

Khatri

et al. 2014

Baylor University Medical Center Proceedings

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Epidural Analgesia for Open Major Liver Resection Surgery from a us Inpatient Sample

Rosero

Cheng

Khatri

et al. 2014

Baylor University Medical Center Proceedings

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“…Epidural analgesia provides superior pain relief after PD than IV PCA; 44 however, the impact of epidural analgesia on postoperative morbidity and mortality is not completely understood. Recent studies have suggested that epidural use results in fewer postoperative complications; 45 in contrast, epidural analgesia has been found to promote hemodynamic instability following PD and possibly contributes to an increased incidence of various gastrointestinal and respiratory complications. 46 Further research is warranted to determine the appropriate method of analgesia following PD in order to optimize pain relief and minimize complications.…”

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confidence: 99%

Canadian practice patterns for pancreaticoduodenectomy

Cyr

Truong

Lam-McCulloch

et al. 2015

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Background: Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD). Methods:We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association. Results:The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet there was minimal agreement with the designated criteria. There was variability in postoperative care, including the use of epidural analgesia and timing of postoperative oral nutrition. Conclusion:We identified heterogeneity among Canadian HPB surgeons, suggesting a number of evidence-practice gaps within specific domains of pancreatic resections. Focused research in these areas may facilitate technical agreement and improve patient outcomes following PD.Contexte : La discordance entre les modes de pratique pourrait être due à des lacunes au plan des pratiques fondées sur des preuves ou à une déficience du transfert des connaissances. Nous avons étudié les stratégies actuellement utilisées par les chirurgiens hépato-pancréato-biliaires (HPB) au Canada pour la prise en charge périopératoire de la pancréatoduodénectomie (PD). Méthodes :Nous avons préparé un questionnaire électronique sur les mesures péri-opératoires entourant la PD. Le questionnaire a été distribué à tous les membres de l'Association hépato-pancréato-biliaire canadienne.Résultats : Le questionnaire a été distribué à 74 chirurgiens et a généré un taux de réponse de 50 %. De nombreuses similitudes dans les techniques chirurgicales ont été signalées : par exemple, la majorité des chirurgiens (86,5 %) reconstruisent le pancréas par pancréatojéjunostomie plutôt que par pancréatogastrostomie. En revanche, on a observé une variabilité dans les techniques d'utilisation des drains péritonéaux, des endoprothèses anastomotiques, des octréotides et autres modalités peropératoires. La majorité des chirurgiens (75,7 %) ont signalé que leurs patients avaient souvent besoin de drains biliaires préopératoires et pourtant, les critères désignés ne semblaient pas faire l'unanimité. On a aussi noté des différences dans les soins postopératoires, y compris en ce qui concerne le recours à l'analgésie péridurale et le moment de la reprise de l'alimentation orale après la chirurgie. Conclusion :Nous avons observé une hétérogénéité dans la pratique des chirurgiens HP...

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Meta‐analysis of epidural analgesia in patients undergoing pancreatoduodenectomy

et al. 2019

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BackgroundThe optimal analgesic technique after pancreatoduodenectomy remains under debate. This study aimed to see whether epidural analgesia (EA) has superior clinical outcomes compared with non‐epidural alternatives (N‐EA) in patients undergoing pancreatoduodenectomy.MethodsA systematic review with meta‐analysis was performed according to PRISMA guidelines. On 28 August 2018, relevant literature databases were searched. Primary outcomes were pain scores. Secondary outcomes were treatment failure of initial analgesia, complications, duration of hospital stay and mortality.ResultsThree RCTs and eight cohort studies (25 089 patients) were included. N‐EA treatments studied were: intravenous morphine, continuous wound infiltration, bilateral paravertebral thoracic catheters and intrathecal morphine. Patients receiving EA had a marginally lower pain score on days 0–3 after surgery than those receiving intravenous morphine (mean difference (MD) −0·50, 95 per cent c.i. −0·80 to −0·21; P < 0·001) and similar pain scores to patients who had continuous wound infiltration. Treatment failure occurred in 28·5 per cent of patients receiving EA, mainly for haemodynamic instability or inadequate pain control. EA was associated with fewer complications (odds ratio (OR) 0·69, 95 per cent c.i. 0·06 to 0·79; P < 0·001), shorter duration of hospital stay (MD −2·69 (95 per cent c.i. −2·76 to −2·62) days; P < 0·001) and lower mortality (OR 0·69, 0·51 to 0 93; P = 0·02) compared with intravenous morphine.ConclusionEA provides marginally lower pain scores in the first postoperative days than intravenous morphine, and appears to be associated with fewer complications, shorter duration of hospital stay and less mortality.

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Effect of epidural analgesia on postoperative complications following pancreaticoduodenectomy

Cited by 38 publications

References 16 publications

Evaluation of Epidural Analgesia for Open Major Liver Resection Surgery from a us Inpatient Sample

Evaluation of Epidural Analgesia for Open Major Liver Resection Surgery from a us Inpatient Sample

Canadian practice patterns for pancreaticoduodenectomy

Meta‐analysis of epidural analgesia in patients undergoing pancreatoduodenectomy

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