The aim of this retrospective study was to evaluate the effect of implementing the combination of thoracic epidural analgesia and multimodal analgesia by a dedicated acute pain service on opioid consumption and postoperative outcomes in patients undergoing pancreaticoduodenectomy. Opioid consumption during postoperative days 0-3 was compared in the acute pain service versus non-acute pain service cohort. Between matched cohorts, the median (quartiles) total opioid consumption during postoperative days 0-3 was 114mg morphine equivalents (54.7, 212.4mg morphine equivalents) in the non-acute pain service cohort and 47.4mg morphine equivalents (38.1, 100.8mg morphine equivalents) in the acute pain service cohort; the median difference was 44.8mg morphine equivalents (95% CI 14.2-90.2mg morphine equivalents, p = 0.002). The median difference in hospital length of stay was 2.0 days (95% confidence interval 0.8-4.0, p = 0.01), favouring the acute pain service cohort. A dedicated acute pain service implementing thoracic epidural analgesia in conjunction with multimodal analgesia was associated with decreased opioid consumption and hospital length of stay.
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