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Updated: Dec 10, 2025

Reverse Needle Continuous Suture of the Pancreatic Duct to Jejunal Mucosal Pancreaticointestinal Anastomosis in Laparoscopic Pancreaticoduodenectomy
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Surgeon-Placed Continuous Wound Infusion Pain Catheters Markedly Decrease Narcotic Use and Improve Outcomes After

Lyonell B Kone1,2, Nicholas M Kunda1,2, Thuy B Tran1,2

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Continuous wound infusion (CWI) significantly reduces opioid use and improves functional outcomes after pancreatic surgery compared to patient-controlled analgesia (PCA) or epidural analgesia (EA). This method offers better pain management without compromising patient comfort.

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Area of Science:

  • Surgical Oncology
  • Anesthesiology
  • Pain Management

Background:

  • Pancreatectomy often leads to severe postoperative pain requiring substantial opioid analgesia.
  • Limitations of traditional local anesthetics include slow onset, short duration, and inability to titrate.
  • Continuous wound infusion (CWI) via surgeon-placed peri-incisional catheters offers a potential solution to overcome these limitations.

Purpose of the Study:

  • To evaluate the efficacy of continuous wound infusion (CWI) in managing postoperative pain and opioid requirements after open pancreatic tumor resection.
  • To compare CWI with patient-controlled analgesia (PCA) and epidural analgesia (EA) in terms of opioid consumption and pain control.
  • To assess the impact of CWI on functional recovery outcomes.

Main Methods:

  • Retrospective cohort study of patients undergoing open pancreatic tumor resection.
  • Comparison of three analgesia groups: CWI (n=45), PCA alone (n=11), and epidural analgesia (EA) (n=9).
  • Primary outcomes measured: total opioid use (MMEs) and Numeric Rating Scale (NRS) pain scores. Secondary outcomes included functional recovery metrics.

Main Results:

  • CWI was associated with significantly lower opioid use compared to PCA (83 vs 207 mg MME) and EA (83 vs 156 mg MME).
  • Patients receiving CWI experienced optimal pain control (NRS ≤ 4) more frequently (63% vs 50% for PCA) and achieved PCA independence sooner (4.0 vs 4.9 days).
  • CWI demonstrated improved functional outcomes, including earlier ambulation, better spirometry performance, and quicker urinary catheter removal compared to EA and PCA.

Conclusions:

  • Continuous wound infusion (CWI) is a safe and effective method for managing pain after open pancreatic tumor resection.
  • CWI significantly reduces opioid requirements and enhances functional recovery without negatively impacting pain scores.
  • CWI shows potential as a preferred alternative to PCA or EA alone for postoperative pain management in pancreatectomy patients.