Randomized Prospective Trial of Epidural Analgesia after Open Hepatectomy

Author:

Arslan-Carlon Vittoria1,Qadan Motaz2,Puttanniah Vinay1,Seier Kenneth3,Gönen Mithat3,Yang Gloria4,Fischer Mary1,DeMatteo Ronald P.5,Kingham T. Peter4,Jarnagin William R.4,D’Angelica Michael I.4

Affiliation:

1. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY

2. Department of Surgery, Massachusetts General Hospital, Boston, MA

3. Department of Biostatistics & Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY

4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY

5. Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA

Abstract

Objective: To evaluate whether patient-controlled epidural analgesia (PCEA) improves postoperative pain during ambulation following elective open hepatectomy. Background: Strategies to alleviate postoperative pain are a critical element of recovery after surgery. However, the optimal postoperative pain management strategy following open hepatectomy remains unclear. Methods: We conducted a prospective, non-blinded, randomized comparison of PCEA (intervention) vs. intravenous patient-controlled analgesia (IV PCA; control) for postoperative pain following elective open hepatectomy. The primary endpoint was pain during ambulation on postoperative day (POD) 2. The study was powered to detect a clinically significant 2-point difference on pain numeric rating scale (NRS). Secondary endpoints included pain at rest, morbidity, time to return of bowel function, and length of stay. Results: From 2015-2020, 231 patients were randomized (116 patients in the PCEA arm and 115 in the IV PCA arm). The incidence of epidural failure was 3% (n=4/116), with no epidural-related complications. Patients in the PCEA arm had a <2 point difference in NRS pain scores during ambulation on POD 2 vs. IV PCA (median 4.0 vs. 5.0, P<0.001). There was no difference in overall complications between the PCEA and IV PCA arms (33% vs. 40%, P=0.276). Secondary outcomes, including pain scores at rest, were similar between the study arms. Conclusions: PCEA was safe following open hepatectomy and was associated with a small difference in pain with activity on POD 2 that did not reach our pre-specified definition of clinical significance.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Epidurale Anästhesie bei offener Hepatektomie;Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie;2024-06

2. Development of an enhanced recovery after surgery program for pediatric solid tumors;Frontiers in Surgery;2024-05-22

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