Comparison of methods of analgesia in patients after pancreatic surgery: a cohort retrospective study

Abstract

AIM: To compare the effectiveness of postoperative analgesia by methods of epidural blockade (EB) and rectus sheath block (RSB) in the early postoperative period in patients who underwent pancreatic surgery.

MATERIALS AND METHODS: A retrospective analysis of inpatient case histories of patients after pancreatic surgery at JSC Ilyinsky Hospital for the period from 2019 to 2021 (n=92) was conducted. For the study, 78 cases were selected, which were divided into two groups: the first group (n=46) received EB with a local anesthetic in the postoperative period, and the second group (n=32) underwent RSB followed by the introduction of a local anesthetic solution.

RESULTS:The level of pain on the visual analog scale was statistically significantly higher in the first group on day 1(1.07 [0.50–1.80] and 0.48 [0.08–1.13], respectively, p=0.013) and day 2 (0.82 [0.25–1.33] and 0.33 [0.06–0.75], respectively, p=0.021), and no differences were found on day 3 (p=0.060). The frequency of additional use of opioid analgesia did not differ between the study groups (day 1, p=0.233; day 2, p=0.570; and day 3, p=0.092 The use of norepinephrine infusion in the early postoperative period (p=0.842), daily and cumulative water balance (day 0, p=0.851; day 1, p=0.883; and day 2, p=0.319; day 3, p=0.718; and cumulative balance, p=0.707), and verticalization time (p=0.800) also showed no significant difference.). Orthostatic reactions during early mobilization were noted significantly more often in the EB group than in the RSB group (n=10, 21.7%; n=1, 3.2%, respectively; OR 8.333, 95% CI 1.008–66.667, p=0.042). The appearance of the first stool was more common in the EB group (3 [2–4] days vs. 4 [3–5] days in the RSB group, p=0.027). No statistically significant difference was found between the groups in the development of infectious complications (p=1.000), gastrostasis (p=0.144), in-hospital mortality rate (p=0.460), ICU days (p=0.305), and lengths of stay (p=0.776).

CONCLUSION: The data obtained in the study show the comparability of the use of analgesia methods, such as EB and RSB in patients who underwent pancreatic surgery.

Keywords

analgesia / pancreatic surgery / epidural blockade / rectus sheath block

References

[1] Fang P, Qian J, Ding J, et al. Comparison of Analgesic Effects between Nalbuphine and Sufentanil in First-Trimester Surgical Abortion: A Randomized, Double-Blind, Controlled Trial. Pain Ther. 2022;11(1):121–132. doi: 10.1007/s40122-021-00334-0

[2] Fang P., Qian J., Ding J., et al. Comparison of Analgesic Effects between Nalbuphine and Sufentanil in First-Trimester Surgical Abortion: A Randomized, Double-Blind, Controlled Trial // Pain Ther. 2022. Vol. 11, N 1. P. 121–132. doi: 10.1007/s40122-021-00334-0

[3] Tyurina EA, Zagorulko OI, Medvedeva LA, et al. Analysis of the factors of pain chronicity in the postoperative period in abdominal surgery. Clinical and Experimental Surgery. Petrovsky Journal. 2022;10(1):108–113. (In Russ). doi: 10.33029/2308-1198-2022-10-1-108-113

[4] Тюрина Е.А., Загорулько О.И., Медведева Л.А., и др. Анализ факторов хронизации боли в послеоперационном периоде в абдоминальной хирургии // Клиническая и экспериментальная хирургия. Журнал имени академика Б.В. Петровского. 2022. Т. 10, № 1. С. 108–113. doi: 10.33029/2308-1198-2022-10-1-108-113

[5] Lovich-Sapola J, Smith CE, Brandt CP. Postoperative Pain Control. Surg Clin North Am. 2015;95(2):301–318. doi: 10.1016/j.suc.2014.10.00

[6] Lovich-Sapola J., Smith C.E., Brandt C.P. Postoperative Pain Control // Surg Clin North Am. 2015. Vol. 95, N 2. P. 301–318. doi: 10.1016/j.suc.2014.10.00

[7] Wilkinson KM, Krige A, Brearley SG, et al. Thoracic Epidural analgesia versus Rectus Sheath Catheters for open midline incisions in major abdominal surgery within an enhanced recovery programme (TERSC): study protocol for a randomised controlled trial. Trials. 2014;15:400. doi: 10.1186/1745-6215-15-400

[8] Wilkinson K.M., Krige A., Brearley S.G., et al. Thoracic Epidural analgesia versus Rectus Sheath Catheters for open midline incisions in major abdominal surgery within an enhanced recovery programme (TERSC): study protocol for a randomised controlled trial // Trials. 2014. N 15. P. 400. doi: 10.1186/1745-6215-15-400

[9] Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109(2):144–154. doi: 10.1093/bja/aes214

[10] Hermanides J., Hollmann M.W., Stevens M.F., Lirk P. Failed epidural: causes and management // Br J Anaesth. 2012. Vol. 109, N 2. P. 144–154. doi: 10.1093/bja/aes214

[11] Krige A, Brearley SG, Mateus C, et al. A comparison between thoracic epidural analgesia and rectus sheath catheter analgesia after open midline major abdominal surgery: randomized clinical trial. BJS Open. 2022;6(3):zrac055. doi: 10.1093/bjsopen/zrac055

[12] Krige A., Brearley S.G., Mateus C., et al. A comparison between thoracic epidural analgesia and rectus sheath catheter analgesia after open midline major abdominal surgery: randomized clinical trial // BJS Open. 2022. Vol. 6, N 3. P. zrac055. doi: 10.1093/bjsopen/zrac055

[13] Manassero A, Bossolasco M, Meineri M, et al. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair. J Anaesthesiol Clin Pharmacol. 2015;31(3):349–353. doi: 10.4103/0970-9185.161671

[14] Manassero A., Bossolasco M., Meineri M., et al. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair // J Anaesthesiol Clin Pharmacol. 2015. Vol. 31, N 3. P. 349–353. doi: 10.4103/0970-9185.161671

[15] Hausken J, Rydenfelt K, Horneland R, et al. First Experience With Rectus Sheath Block for Postoperative Analgesia After Pancreas Transplant: A Retrospective Observational Study. Transplant Proc. 2019;51(2):479–484. doi: 10.1016/j.transproceed.2019.01.065

[16] Hausken J., Rydenfelt K., Horneland R., et al. First Experience With Rectus Sheath Block for Postoperative Analgesia After Pancreas Transplant: A Retrospective Observational Study // Transplant Proc. 2019. Vol. 51, N 2. P. 479–484. doi: 10.1016/j.transproceed.2019.01.065

[17] Holte K, Foss NB, Svensén C, et al. Epidural Anesthesia, Hypotension, and Changes in Intravascular Volume. Anesthesiology. 2004;100(2):281–286. doi: 10.1097/00000542-200402000-00016

[18] Holte K., Foss N.B., Svensén C., et al. Epidural Anesthesia, Hypotension, and Changes in Intravascular Volume // Anesthesiology. 2004. Vol. 100, N 2. P. 281–286. doi: 10.1097/00000542-200402000-00016

[19] Axelrod TM, Mendez BM, Abood GJ, et al. Peri-operative epidural may not be the preferred form of analgesia in select patients undergoing pancreaticoduodenectomy. J Surg Oncol. 2015;111(3):306–310. doi: 10.1002/jso.23815

[20] Axelrod T.M., Mendez B.M., Abood G.J., et al. Peri-operative epidural may not be the preferred form of analgesia in select patients undergoing pancreaticoduodenectomy // J Surg Oncol. 2015. Vol. 111, N 3. P. 306–310. doi: 10.1002/jso.23815

[21] Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med. 2015;277(1):58–68. doi: 10.1111/joim.12326

[22] Myburgh J.A. Fluid resuscitation in acute medicine: what is the current situation? // J Intern Med. 2015. Vol. 277, N 1. P. 58–68. doi: 10.1111/joim.12326

[23] Joosten A, Delaporte A, Ickx B, et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System. Anesthesiology. 2018;128(1):55–66. doi: 10.1097/ALN.0000000000001936

[24] Joosten A., Delaporte A., Ickx B., et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System // Anesthesiology. 2018. Vol. 128, N 1. P. 55–66. doi: 10.1097/ALN.0000000000001936

[25] Wink J, Veering BT, Aarts LPHJ, Wouters PF. Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function. Anesthesiology. 2019;130(3):472–491. doi: 10.1097/ALN.0000000000002558

[26] Wink J., Veering B.T., Aarts L.P.H.J., Wouters P.F. Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function // Anesthesiology. 2019. Vol. 130, N 3. P. 472–491. doi: 10.1097/ALN.0000000000002558

[27] Wright GP, Koehler TJ, Davis AT, Chung MH. The drowning whipple: Perioperative fluid balance and outcomes following pancreaticoduodenectomy. J Surg Oncol. 2014;110(4):407–411. doi: 10.1002/jso.23662

[28] Wright G.P., Koehler T.J., Davis A.T., Chung M.H. The drowning whipple: Perioperative fluid balance and outcomes following pancreaticoduodenectomy // J Surg Oncol. 2014. Vol. 110, N 4. P. 407–411. doi: 10.1002/jso.23662

[29] Jans Ø, Kehlet H. Postoperative orthostatic intolerance: a common perioperative problem with few available solutions. Can J Anaesth. 2017;64(1):10–15. doi: 10.1007/s12630-016-0734-7

[30] Jans Ø., Kehlet H. Postoperative orthostatic intolerance: a common perioperative problem with few available solutions // Can J Anaesth. 2017. Vol. 64, N 1. P. 10–15. doi: 10.1007/s12630-016-0734-7

[31] Haines KJ, Skinner EH, Berney S, et al. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy. 2013;99(2):119–125. doi: 10.1016/j.physio.2012.05.013

[32] Haines K.J., Skinner E.H., Berney S., et al. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study // Physiotherapy. 2013. Vol. 99, N 2. P. 119–125. doi: 10.1016/j.physio.2012.05.013

[33] Iwata Y, Mizota Y, Mizota T, et al. Postoperative continuous intravenous infusion of fentanyl is associated with the development of orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery. J Anesth. 2012;26(4):503–508. doi: 10.1007/s00540-012-1391-9

[34] Iwata Y., Mizota Y., Mizota T., et al. Postoperative continuous intravenous infusion of fentanyl is associated with the development of orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery // J Anesth. 2012. Vol. 26, N 4. P. 503–508. doi: 10.1007/s00540-012-1391-9

[35] Jans Ø, Bundgaard-Nielsen M, Solgaard S, et al. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. Br J Anaesth. 2012;108(3):436–443. doi: 10.1093/bja/aer403

[36] Jans Ø., Bundgaard-Nielsen M., Solgaard S., et al. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty // Br J Anaesth. 2012. Vol. 108, N 3. P. 436–443. doi: 10.1093/bja/aer403

[37] Müller RG, Bundgaard-Nielsen M, Kehlet H. Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery. Br J Anaesth. 2010;104(3):298–304. doi: 10.1093/bja/aep381

[38] Müller R.G., Bundgaard-Nielsen M., Kehlet H. Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery // Br J Anaesth. 2010. Vol. 104, N 3. P. 298–304. doi: 10.1093/bja/aep381

[39] Bundgaard-Nielsen M, Jørgensen CC, Jørgensen TB, et al. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth. 2009;102(6):756–762. doi: 10.1093/bja/aep083

[40] Bundgaard-Nielsen M., Jørgensen C.C., Jørgensen T.B., et al. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization // Br J Anaesth. 2009. Vol. 102, N 6. P. 756–762. doi: 10.1093/bja/aep083

[41] Holte K, Kehlet H. Postoperative Ileus. Drugs. 2002;62(18):2603–2615. doi: 10.2165/00003495-200262180-00004

[42] Holte K., Kehlet H. Postoperative Ileus // Drugs. 2002. Vol. 62, N 18. P. 2603–2615. doi: 10.2165/00003495-200262180-00004

[43] McCarthy GC, Megalla SA, Habib AS. Impact of Intravenous Lidocaine Infusion on Postoperative Analgesia and Recovery from Surgery. Drugs. 2010;70(9):1149–1163. doi: 10.2165/10898560-000000000-00000

[44] McCarthy G.C., Megalla S.A., Habib A.S. Impact of Intravenous Lidocaine Infusion on Postoperative Analgesia and Recovery from Surgery // Drugs. 2010. Vol. 70, N 9. P. 1149–1163. doi: 10.2165/10898560-000000000-00000

[45] Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016;7(7):CD001893. doi: 10.1002/14651858.CD001893.pub2

[46] Guay J., Nishimori M., Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery // Cochrane Database Syst Rev. 2016. Vol. 7, N 7. P. CD001893. doi: 10.1002/14651858.CD001893.pub2

[47] Yassin HM, Abd Elmoneim AT, El Moutaz H. The Analgesic Efficiency of Ultrasound-Guided Rectus Sheath Analgesia Compared with Low Thoracic Epidural Analgesia After Elective Abdominal Surgery with a Midline Incision: A Prospective Randomized Controlled Trial. Anesthesiol Pain Med. 2017;7(3):e14244. doi: 10.5812/aapm.14244

[48] Yassin H.M., Abd Elmoneim A.T., El Moutaz H. The Analgesic Efficiency of Ultrasound-Guided Rectus Sheath Analgesia Compared with Low Thoracic Epidural Analgesia After Elective Abdominal Surgery with a Midline Incision: A Prospective Randomized Controlled Trial // Anesthesiol Pain Med. 2017. Vol. 7, N 3. P. e14244. doi: 10.5812/aapm.14244

[49] Kontorev KV, Zdzitovetsky DE, Borisov RN. The role of local anesthesia of a laparotomic wound in the prevention of postoperative complications. The Bulletin of Contemporary Clinical Medicine. 2022;15(1):118–124. (In Russ). doi: 10.20969/VSKM.2022.15(1).118-124

[50] Конторев К.В., Здзитовецкий Д.Э., Борисов Р.Н. Роль местной анестезии лапаротомной раны в профилактике послеоперационных осложнений // Вестник современной клинической медицины. 2022. Т. 15, № 1. С. 118–124. doi: 10.20969/VSKM.2022.15(1).118-124

[51] Bespalov EK, Zaitsev AY, Svetlov VA, Vyzhigina MA. Fascial-sheath regional anesthesia for operations on the anterior abdominal wall and abdominal organs. Regional Anesthesia and Acute Pain Management. 2021;15(1):19–32. (In Russ). doi: 10.17816/1993-6508-2021-15-1-19-32

[52] Беспалов Е.К., Зайцев А.Ю., Светлов В.А., Выжигина М.А. Фасциально-футлярная регионарная анестезия при операциях на передней брюшной стенке и органах брюшной полости // Регионарная анестезия и лечение острой боли. 2021. Т. 15, № 1. С. 19–32. doi: 10.17816/1993-6508-2021-15-1-19-32

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