Advantage of patient-controlled epidural analgesia in patients undergoing laparoscopic surgery for pancreatic cancer: evidence from a retrospective study

Abstract

Abstract Background Patient-controlled epidural analgesia (PCEA) has been recognized to provide better postoperative analgesia than patient-controlled intravascular analgesia (PCIA) for patients undergoing many types of surgery. However, there is no comparison of the two analgesic methods in patients undergoing pancreatic cancer resection, especially laparoscopic radical resection of pancreatic cancer (LARP). In this study, the effectiveness and side effects of PCEA and PCIA after LARP were compared. Methods:Patients (n=296) who underwent laparoscopic surgery for pancreatic cancer from September 2021 to June 2022 at Fudan University Shanghai Cancer Centre (FUSCC) were included. The patients were divided into PCEA group and PCIA group according to the analgesia protocols after surgery. Propensity score matching was used to minimize bias. The efficacy of analgesia, side effects after surgery, inflammatory levels in perioperative period, and postoperative satisfaction of patients were compared between two groups. Results: Two hundred eighty-five patients were screened by propensity score matching and 66 patients in each group were included in final analysis. The patients in PCEA group had lower pain scores at rest on the first postoperative day (P=0.025). Compared to PCIA group, the time to first passage of flatus after surgery was shorter in the PCEA group (P<0.001). The length of hospital stay had no significant differences between two groups. In term of the complications after surgery, we found that PCEA group had the higher incidence of itching and hypotension (P=0.029 and P=0.016, respectively). Additionally, PCEA group had the lower-level inflammation after surgery and less opioid consumption. Patients in PCEA group were more satisfied with our anesthesia process (P=0.042). Conclusion: PCEA showed better postoperative analgesia, lower inflammatory response and higher patient satisfaction than PCIA after LARP, which supports thtat PCEA is the more suitable analgesic method than PICA.