Equivalent Pain and Opioid Use Between Transabdominal and Retroperitoneal Adrenalectomy

Laparoscopic transabdominal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA) are safe, effective surgical approaches. A direct comparison of postoperative pain and narcotic use is needed.

Adults who had laparoscopic adrenalectomy at a tertiary institution from 2015 to 2021 were identified from a surgical database. Evaluated key outcomes included opioid use and patient-reported pain during the perioperative period, which were analyzed by surgical approach and compared using multivariate linear regression. Additional data on pain postdischarge, prescription refills, length of stay, and 30-d readmission were also collected.

Eighty-eight (69.3%) surgeries were LTA and 39 (30.7%) were PRA. The studied patient population was 58% female and had an average age of 54 (standard deviation 13). Adrenal tumors were 75% functional and 3.4 cm on average (standard deviation 2.6). Postoperative pain scores at rest (4.4 LTA versus 4.5 PRA, P = 0.87) and activity (4.7 LTA versus 5.6 PRA, P = 0.08) did not reach statistical significance. Patients undergoing LTA used a median of 110.3 morphine milligram equivalents (interquartile range 70.1-144.5) of opioids during their hospital stay compared to 91.0 (interquartile range 59.1-133.3) for PRA (P = 0.16). Linear regression demonstrated no significant difference in postoperative opioid use between approaches (-9.3 morphine milligram equivalents [95% confidence interval -40.7 to 22.1]).

Our analysis found no significant advantage of PRA over LTA in terms of postoperative pain or opioid use, contrary to earlier findings by Barczyński et al., who reported lower postoperative pain with PRA. Both approaches show similar clinical outcomes, and the choice between them should be based on individual patient factors rather than differences in patient-reported pain and opioid usage.