Epidural and Non-epidural Analgesia in Patients Undergoing Open Pancreatectomy: a Retrospective Cohort Study

Groen, Jesse V.; Slotboom, D.; Vuyk, Jaap; Martini, C.H.; Dahan, Albert; Vahrmeijer, Alexander L.; Bonsing, Bert A.; Mieog, J. Sven D.

doi:10.1007/s11605-019-04136-w

Cited by 12 publications

(28 citation statements)

References 33 publications

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“…53 Compared to systemic analgesia, the administration of ropivacaine and sufentanil for 72 hours through an extradural catheter was associated with lower pain scores in human patients undergoing pancreatectomy. 54 Postoperative pancreatitis was considered the main complication after partial pancreatectomies and it was also the reason for euthanasia in three dogs that underwent glucagonoma surgical excision. 2,4 As consequence, ensuring adequate visceral blood perfusion during anaesthesia, promoting enteral nutrition and analgesia in the postoperative period are considered essential.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a cat with diabetes mellitus undergoing glucagonoma excision

Bellido¹,

Monticelli²,

Vettorato³

2022

Vet Record Case Reports

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An 11‐year‐old, 3.3 kg, male neutered, domestic longhair cat with poorly controlled diabetes mellitus was referred for surgical excision of a glucagonoma – a pancreatic tumour that produces an excessive amount of glucagon. Methadone was administered intravenously, and anaesthesia was induced intravenously with alfaxalone and maintained with sevoflurane in 100% oxygen. An extradural catheter was placed at the lumbo‐sacral site and its tip was advanced approximately to the second lumbar vertebrae. Preservative‐free buprenorphine and 0.5% levobupivacaine were administered. Intraoperatively, haemodynamic changes were monitored using a non‐invasive cardiac output monitor. During anaesthesia, hyperglycaemia and hypotension were the two main complications recorded. Postoperative analgesia was provided administering 0.25% levobupivacaine extradurally every 4 hours for the first 24 hours. The blood glucose concentration decreased postoperatively, and insulin administration was restarted 7 hours after surgery when the cat started eating voluntarily. No other complications occurred, and the cat was discharged from the hospital 72 hours after the surgery.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a cat with diabetes mellitus undergoing glucagonoma excision

Bellido¹,

Monticelli²,

Vettorato³

2022

Vet Record Case Reports

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“…Epidural analgesia (EA) is the gold standard for perioperative analgesic management in most major open abdominal surgeries. 1 Recently, we performed a systematic review of the various analgesic treatment strategies after pancreatoduodenectomy in our own center 2 and in the current literature. 3 The reported use of EA in patients undergoing pancreatoduodenectomy varies from 9% to 85%.…”

Section: Introductionmentioning

confidence: 99%

“… 3 The potential benefits of EA are lower pain scores in the first postoperative days and fewer postoperative (pulmonary) complications. 2 , 3 The disadvantages of EA are the invasive nature, early failure rates, hemodynamic instability and notorious, albeit uncommon, complications (eg spinal hematoma and epidural infections). 2–6 The most used alternative to EA is intravenous (iv) morphine.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 The disadvantages of EA are the invasive nature, early failure rates, hemodynamic instability and notorious, albeit uncommon, complications (eg spinal hematoma and epidural infections). 2–6 The most used alternative to EA is intravenous (iv) morphine. 1–3 , 7 _ENREF_3 The advantages of iv morphine are that most patients are eligible (eg patients with coagulation disorders or spine anatomy alterations) and that it is a less invasive method compared to EA.…”

Section: Introductionmentioning

confidence: 99%

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Sublingual Sufentanil versus Standard-of-Care (Patient-Controlled Analgesia with Epidural Ropivacaine/Sufentanil or Intravenous Morphine) for Postoperative Pain Following Pancreatoduodenectomy: A Randomized Trial

Groen¹,

Boon²,

Minderhoud³

et al. 2022

JPR

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Background The optimal treatment strategy for postoperative pain following pancreatoduodenectomy remains unknown. The aim of this study was to investigate whether sublingual sufentanil tablet (SST) is a non-inferior analgesic compared to our standard-of-care (patient-controlled epidural analgesia [PCEA] or PCA morphine) in the treatment of pain following pancreatoduodenectomy. Methods This was a pragmatic, strategy, open-label, non-inferiority, parallel group, randomized (1:1) trial. The primary outcome was an overall mean pain score (Numerical Rating Scale: 0–10) on postoperative days 1 to 3 combined. The non-inferiority margin was −1.5 since this difference was considered clinically relevant. Results Between October 2018 and July 2021, 190 patients were assessed for eligibility and 36 patients were included in the final analysis: 17 patients were randomized to SST and 19 patients to standard-of-care. Early treatment failure in the SST group occurred in 2 patients (12%) due to inability to operate the SST system and in 2 patients (12%) due to severe nausea despite antiemetics. Early treatment failure in the standard-of-care group occurred in 2 patients (11%) due to preoperative PCEA placement failure and in 1 patient (5%) due to hemodynamic instability caused by PCEA. The mean difference in pain score on postoperative day 1 to 3 was −0.10 (95% CI −0.72–0.52), and therefore the non-inferiority of SST compared to standard-of-care was demonstrated. The mean pain score, number of patients reporting unacceptable pain (pain score >4), Overall Benefit of Analgesia Score, and patient satisfaction per postoperative day, perioperative hemodynamics and postoperative outcomes did not differ significantly between groups. Conclusion This first randomized study investigating the use of SST in 36 patients following pancreatoduodenectomy showed that SST is non-inferior compared to our standard-of-care in the treatment of pain on postoperative days 1 to 3. Future research is needed to confirm that these findings are applicable to other settings.

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“…Although a variety of pain modalities have been explored for the management of postoperative pain after pancreatic surgery, the literature is generally limited to pair-wise comparisons, small study sizes and heterogeneity in their study population [2,5,8,9,[11][12][13][14][15][16][17][18][19][20][21][22][23] making it difficult to justify routine use of one pain modality over the other. This is reflected in the recently published ERAS guidance [6] which recommends EDA for postoperative pain relief and TAWC as an alternative, however the majority of evidence for this recommendation was extrapolated from non-pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta‐Analysis of Analgesic Modalities

et al. 2021

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Background This systematic review explored the efficacy of different pain relief modalities used in the management of postoperative pain following pancreatoduodenectomy (PD) and distal pancreatectomy (DP) and impact on perioperative outcomes. Methods MEDLINE (OVID), Embase, Pubmed, Web of Science and CENTRAL databases were searched using PRISMA framework. Primary outcomes included pain on postoperative day 2 and 4 and respiratory morbidity. Secondary outcomes included operation time, bile leak, delayed gastric emptying, postoperative pancreatic fistula, length of stay, and opioid use. Results Five randomized controlled trials and seven retrospective cohort studies (1313 patients) were included in the systematic review. Studies compared epidural analgesia (EDA) (n = 845), patient controlled analgesia (PCA) (n = 425) and transabdominal wound catheters (TAWC) (n = 43). EDA versus PCA following PD was compared in eight studies (1004 patients) in the quantitative meta-analysis. Pain scores on day 2 (p = 0.19) and 4 (p = 0.18) and respiratory morbidity (p = 0.42) were comparable between EDA and PCA. Operative times, bile leak, delayed gastric emptying, pancreatic fistula, opioid use, and length of stay also were comparable between EDA and PCA. Pain scores and perioperative outcomes were comparable between EDA and PCA following DP and EDA and TAWC following PD. Conclusions EDA, PCA and TAWC are the most frequently used analgesic modalities in pancreatic surgery. Pain relief and other perioperative outcomes are comparable between them. Further larger randomized controlled trials are warranted to explore the relative merits of each analgesic modality on postoperative outcomes with emphasis on postoperative complications.

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Epidural and Non-epidural Analgesia in Patients Undergoing Open Pancreatectomy: a Retrospective Cohort Study

Cited by 12 publications

References 33 publications

Anaesthetic management of a cat with diabetes mellitus undergoing glucagonoma excision

Anaesthetic management of a cat with diabetes mellitus undergoing glucagonoma excision

Sublingual Sufentanil versus Standard-of-Care (Patient-Controlled Analgesia with Epidural Ropivacaine/Sufentanil or Intravenous Morphine) for Postoperative Pain Following Pancreatoduodenectomy: A Randomized Trial

Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta‐Analysis of Analgesic Modalities

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