Perioperative Pain Management for Complex Pancreatic Resections for Patients with Chronic Pancreatitis

Area of Science:

• Anesthesiology
• Gastroenterology
• Surgical Pain Management

Background:

• Post-surgical pain control in chronic pancreatitis is challenging.
• Epidural analgesia is contraindicated in some procedures like total pancreatectomy with islet cell auto-transplantation (TPIAT).
• Ketamine's efficacy and safety as an alternative analgesic require evaluation.

Purpose of the Study:

• To assess ketamine's effectiveness in pain management for chronic pancreatitis patients undergoing pancreatectomy.
• To compare ketamine analgesia with epidural analgesia in this patient population.
• To evaluate the safety and complication profile of ketamine versus epidural analgesia.

Main Methods:

• A single-center cohort study included 65 patients (aged ≥16) with chronic pancreatitis undergoing pancreatectomy.
• Patients were divided into ketamine infusion and epidural analgesia groups.
• Primary outcome: change in morphine milligram equivalent (MME) from pre-op to discharge; Secondary outcomes: pain scores (post-op days 1-5) and complications.

Main Results:

• No significant difference in opioid consumption (MME) between ketamine and epidural groups at discharge.
• Similar pain scores were observed between the two groups.
• Adverse events were minimal; hallucinations were the most common ketamine-related reaction (n=4).

Conclusions:

• Ketamine provides comparable opioid-sparing analgesia to epidural analgesia in chronic pancreatitis patients.
• Ketamine is a viable and promising adjunctive analgesic for managing post-pancreatectomy pain.
• Further research may support broader use of ketamine in complex pancreatic surgery pain management.