Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy-A Systematic Review and Meta-Analysis

Area of Science:

• Surgical Oncology
• Pain Management
• Anesthesiology

Background:

• Pancreatoduodenectomy is a major surgery with significant postoperative pain.
• Effective pain management is crucial for patient recovery and outcomes.
• Various analgesic modalities exist, but their comparative efficacy requires systematic evaluation.

Purpose of the Study:

• To systematically review and compare the efficacy of different analgesic modalities for pain control after pancreatoduodenectomy.
• To assess the impact of these modalities on perioperative outcomes, including length of hospital stay and complications.

Main Methods:

• Systematic literature search across major databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library) adhering to PRISMA guidelines.
• Inclusion of randomized controlled trials and retrospective cohort studies.
• Primary outcome: pain scores on postoperative days 1 and 2. Secondary outcomes: length of hospital stay and procedure-related complications.

Main Results:

• Epidural analgesia (EA) demonstrated significantly lower pain scores on postoperative day 1 (POD1) and day 2 (POD2) compared to patient-controlled analgesia (PCA).
• Pain scores were comparable between EA and continuous wound infiltration (CWI) plus PCA, or continuous bilateral thoracic paravertebral infusion (CTPVI) on POD1 and POD2.
• No significant differences in length of hospital stay or procedure-related complications were observed across the studied analgesic groups.

Conclusions:

• Epidural analgesia (EA) is more effective than patient-controlled analgesia (PCA) in reducing immediate postoperative pain following pancreatoduodenectomy.
• Continuous wound infiltration (CWI) and continuous bilateral thoracic paravertebral infusion (CTPVI) offer comparable pain relief to EA.
• The choice of analgesic modality did not significantly impact hospital stay or complication rates.