AI Article Synopsis
- The study compares the effectiveness of continuous wound infusion (CWI) of local anesthetic with thoracic epidural analgesia (TEA) for postoperative pain management after pancreaticoduodenectomy (PD).
- Results showed that while TEA provided better pain relief at rest and while coughing on the second postoperative day, CWI was equally effective for overall pain management across the first five days post-surgery.
- CWI allowed for quicker recovery milestones, such as faster bowel movements and diet initiation, along with lower rates of analgesic failure and nausea/vomiting compared to TEA.
Article Abstract
Background: The current gold standard for postoperative analgesia following a pancreaticoduodenectomy (PD) is a thoracic epidural analgesia (TEA). Spinal analgesia with continuous wound infusion (CWI) of local anaesthetic is an emerging alternative modality. This non-inferiority study aimed to compare CWI with spinal analgesia to TEA and assess its impact on clinical outcomes.
Methods: A retrospective observational analysis of patients undergoing open pancreatoduodenectomy through a midline laparotomy. A total of 74 patients were included in the study forming two groups: CWI (n = 33) and TEA (n = 41).
Results: TEA resulted in lower median pain scores at rest (p = 0.002) and with coughing (p = 0.005) on postoperative day 2. CWI was non-inferior to TEA for all other pain outcomes measures from days 0-5. Patients in the CWI group had a shorter time to first bowel motion (p = 0.001), commencement of a liquid diet (p = 0.04), earlier removal of nasogastric tube (p = 0.005), abdominal drain (p = 0.003) and indwelling catheter (p < 0.001). Analgesic failure and postoperative nausea and vomiting were also less frequent (p = 0.001 and p < 0.001 respectively).
Conclusion: Local CWI with spinal analgesia was non-inferior to TEA for pain management in open pancreaticoduodenectomy. CWI demonstrated advantages in measures associated with enhanced recovery after surgery programs without disadvantages in terms of analgesia requirements.
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| http://dx.doi.org/10.1007/s00423-024-03534-2 | DOI Listing |
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