A randomized Clinical Trial to Compare the Efficacy of Continuous Local Anesthetic Wound Infusion with Thoracic Epidural Analgesia in Post-operative Pain Control after Pancreatic Surgery. | [Anaesthesia, Pain and Intensive Care • 2015]

Author(s):

1. Maria Rosaria Spoto: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

2. Paola Zito: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

3. Andrea Forastieri Molinari: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

4. Giovanni Capretti: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

5. Francesca Gavazzi: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

6. Cristina Ridolfi: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

7. Stefania Grimaldi: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

8. Samantha Pesce: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

9. Paola Allavena: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

10. Alessandro Zerbi: Humanitas Clinical and Research Center, via Manzoni, Rozzano (MI), Italy

Abstract:

Introduction: Few data support the use of thoracic epidural analgesia (TEA) in pancreatic surgery. Recent evidence suggested that the use of continuous wound local anesthetic infusion (CWI) could be a reliable and effective procedure in different types of surgeries. The aim of this study was to determine if CWI could be an alternative to TEA in pancreatic surgery. Methodology: Eighty consecutive patients that received a subcostal incision for pancreatic resection from April 2012 to February 2013 in our institute were randomized into two groups to receive either postoperative TEA or CWI. Patients with contraindications to epidural analgesia or any drugs in the protocol, not able to comply with the protocol or use a PCA device were excluded. Rescue analgesia was provided to all patients via patient-controlled analgesia (PCA) which delivered boluses of morphine. Postoperative pain levels where considered as primary end point, and evaluated with Verbal Numeric Scale (VNS). As secondary end points, we studied consumption of morphine, postoperative complications, length of stay, resumption of complete bowel function, and time to mobilization. Circulating cytokines and chemokines were evaluated in 20 patients to assess the effects on the inflammatory response. Results: None of the two techniques demonstrated advantages in terms of static and dynamic postoperative pain control (VNS). Median morphine consumption was not significantly different in TEA [12 mg (IQR 9-23)] and in CWI group [15 mg (IQR 10-29)] (p = 0.527). There was no significant difference between the two groups with regards to secondary endpoints. The median length of stay was comparable in CWI and TEA group [10 (IQR 9-16) vs 12 (IQR 8-15,5)] days; (p = 0.481). Similar levels of inflammatory mediators were found. In the TEA group 13% of the patients experienced hypotension; no such cases where observed in CWI group. Conclusions: Our study failed to demonstrate a superiority of TEA compared to CWI in management of postoperative pain after pancreatic surgery.

Page(s): 429-436

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 19, Issue: 4, Year: 2015

Keywords:

Keywords are not available for this article.

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