Author:
van der Veen Arjen,Ramaekers Mark,Marsman Marije,Brenkman Hylke J. F.,Seesing Maarten F. J.,Luyer Misha D. P.,Nieuwenhuijzen Grard A. P.,Stoot Jan H. M. B.,Tegels Juul J. W.,Wijnhoven Bas P. L.,de Steur Wobbe O.,Kouwenhoven Ewout A.,Wassenaar Eelco B.,Draaisma Werner A.,Gisbertz Suzanne S.,van der Peet Donald L.,May Anne M.,Ruurda Jelle P.,van Hillegersberg Richard,Haverkamp Leonie,Ponten Jeroen E. H.,Heesakkers Fanny F. B. M.,Hulsewe Karel W. E.,Tweed Thais T. T.,Lagarde Sjoerd M.,van Lanschot Jan J. B.,Hartgrink Henk H.,van Det Marc J.,van Duijvendijk Peter,van der Zaag Edwin S.,Broeders Ivo A. M. J.,van Berge Henegouwen Mark I.,Daams Freek,
Abstract
Abstract
Background
Laparoscopic gastrectomy could reduce pain and opioid consumption, compared to open gastrectomy. However, it is difficult to judge the clinical relevance of this reduction, since these outcomes are reported in few randomized trials and in limited detail.
Methods
This secondary analysis of a multicenter randomized trial compared laparoscopic versus open gastrectomy for resectable gastric adenocarcinoma (cT1-4aN0-3bM0). Postoperative pain was analyzed by opioid consumption in oral morphine equivalents (OME, mg/day) at postoperative day (POD) 1–5, WHO analgesic steps, and Numeric Rating Scales (NRS, 0–10) at POD 1–10 and discharge. Regression and mixed model analyses were performed, with and without correction for epidural analgesia.
Results
Between 2015 and 2018, 115 patients in the laparoscopic group and 110 in the open group underwent surgery. Some 16 patients (14%) in the laparoscopic group and 73 patients (66%) in the open group received epidural analgesia. At POD 1–3, mean opioid consumption was 131, 118, and 53 mg OME lower in the laparoscopic group, compared to the open group, respectively (all p < 0.001). After correcting for epidural analgesia, these differences remained significant at POD 1–2 (47 mg OME, p = 0.002 and 69 mg OME, p < 0.001, respectively). At discharge, 27% of patients in the laparoscopic group and 43% patients in the open group used oral opioids (p = 0.006). Mean highest daily pain scores were between 2 and 4 at all PODs, < 2 at discharge, and did not relevantly differ between treatment arms.
Conclusion
In this multicenter randomized trial, postoperative pain was comparable between laparoscopic and open gastrectomy. After laparoscopic gastrectomy, this was generally achieved without epidural analgesia and with fewer opioids.
Trial Registration
NCT02248519.
Publisher
Springer Science and Business Media LLC
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