Postoperative pain management following minimally invasive abdominal cancer surgeries -An audit

There is limited data comparing pain management following various minimally invasive oncological surgeries (MIOS). This retrospective audit was planned to determine the severity of pain and to study the analgesic modalities offered to these patients. Secondary objectives included studying opioid requirements, non-opioid analgesics, their side effects, and the influence of comorbidities on the choice of pain modalities.

Following approval and registration of trial (CTRI/2018/10/016220), data were collected retrospectively from adult patients who underwent elective MIOS for abdominal tumors from August 2017 to July 2018. Pain scores (PS) on the day of surgery, and the average, worst PS, and the morphine equivalent (ME) dose in the perioperative period was recorded. Emergency surgeries and thoracic-abdominal MIOS were excluded. The association between the type of surgery, pain modalities, and PS were compared using Chi-square test. ME dose consumption of patients and type of surgery were compared using ANOVA with Bonferroni's correction.

Out of the 349 patients' data that were analyzed, 76% had mild, 22% had moderate, and 2% had severe pain after surgery. Port site infiltration was done in 27% of cases and epidural analgesia in 46 patients (13%). PS and opioid consumption (ME = 5.7 ± 5.2 mg) was significantly higher following pelvic surgeries when compared to other urological and diagnostic MIOS. American Society of Anesthesiologists Physical Status did not affect PS or choice of pain management technique.

Most of the patients experience mild pain at movement in the immediate postoperative period, pelvic MIOS (abdominoperineal resection/exenteration surgeries) have higher PS and opioid consumption than other MIOS.