Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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A comparative study on analgesic and non-analgesic outcomes of inter pleural analgesia compared to thoracic epidural analgesia in open pancreatico-duodenectomy

  • Lu Yao (Division of Hepato-Pancreatico-Biliary Surgery Unit, University Hospitals Plymouth NHS Trust) ;
  • Niroshini Rajaretnam (Division of Hepato-Pancreatico-Biliary Surgery Unit, University Hospitals Plymouth NHS Trust) ;
  • Natalie Smith (Division of Hepato-Pancreatico-Biliary Surgery Unit, University Hospitals Plymouth NHS Trust) ;
  • Lisa Massey (Division of Hepato-Pancreatico-Biliary Surgery Unit, University Hospitals Plymouth NHS Trust) ;
  • Somaiah Aroori (Division of Hepato-Pancreatico-Biliary Surgery Unit, University Hospitals Plymouth NHS Trust)
  • Received : 2021.10.28
  • Accepted : 2021.12.29
  • Published : 2022.08.31
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Abstract

Backgrounds/Aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; p = 0.027). TEA complications included analgesia not working (n = 4), leakage (n = 2), refractory hemodynamic instability (n = 1), and lower limb anaesthesia (n = 1). One patient in the IPA group encountered leakage. TEA was associated with longer inotrope requirement (35 vs. 18 hours; p = 0.047). There was no significant difference in intensive care unit (ITU) admission rate (81.8% vs. 77.8%; p > 0.999), median ITU stay (3 vs. 2 days, p = 0.385), or hospital stay (11 days in both groups). Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.

Keywords

Acknowledgement

The authors thank Mr. Muhammed Abdalkoddus and Professor Shangming Zhou for assisting with the statistical analysis and the Plymouth University Hospital Hepto-Pancreatico-Biliary performance team for obtaining the patient list.

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