Postoperative Pain Relief After Pancreatic Resection: Systematic Review and Meta-Analysis of Analgesic Modalities

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2021 Jun 29

PMID 34185150

Citations 7

Authors

Nasreen Akter

Bathiya Ratnayake

Daniel B Joh

Sara-Jane Chan

Emily Bonner

Sanjay Pandanaboyana

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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Delayed gastric emptying after pancreatoduodenectomy: an analysis of risk factors.

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Ratnasekara V, Weinberg L, Johnston S, Fletcher L, Nugraha P, Cox D PLoS One. 2023; 18(9):e0291108.

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Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy-A Systematic Review and Meta-Analysis.

Margarit S, Bartos A, Laza L, Osoian C, Turac R, Bondar O J Clin Med. 2023; 12(14).

PMID: 37510799 PMC: 10380756. DOI: 10.3390/jcm12144682.

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