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

Abstract

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.

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

“…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]. In our study, there were two patients in the EGA group and one patient in the GA group who could not use EA because of hypotension.…”

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

“…[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] In our study, there were two patients in the EGA group and one patient in the GA group who could not use EA because of hypotension.…”

Lower rate of delayed graft function is observed when epidural analgesia for living donor nephrectomy is administered

“…The benefits of EDA regarding pain control, ICU stay, intestinal motility and early mobilization are frequently reported [ 22 – 27 ]. The beneficial effects of EDA in terms of pain control and return to normal daily activities specifically for kidney donors have also been reported in the past [ 28 , 29 ].…”