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

Pain control following surgery for chronic pancreatitis presents a significant challenge. Options like epidurals used in parenchymal preserving pancreatic surgery (PPS) are contraindicated in certain settings such as total pancreatectomy (TP) with islet cell auto-transplantation (IAT). Our aim is to assess the efficacy and safety of ketamine in these patients and compare it to that of epidural analgesia.

A single-center, cohort study was conducted in patients 16 years or older with chronic pancreatitis from August 2017 to May 2023 who underwent pancreatectomy. Patients were stratified based on ketamine infusion group vs epidural group. Primary outcome was change in morphine milligram equivalent (MME) from preoperative to discharge. Secondary outcomes were pain scores at postoperative day one to five and associated complications.

Sixty-five patients were included (ketamine group 26 (40%) and epidural 39 (60%)). Ninety six percent (25/26) of patients in the ketamine group underwent TPIAT and 87% of patients in the epidural group (34/39) underwent PPS. There was no difference in opioid consumption preoperatively, or at time of discharge [ketamine, median MME 75 (IQR 47-90) vs epidural, median MME 60 (IQR 45-90), P=0.279] and in pain scores. Adverse events were minimal, with hallucinations (n=4) as the most common ketamine related reaction.

Ketamine provided similar opioid sparing analgesia compared to opioid epidurals. Ketamine is a promising adjunctive analgesic in patients with chronic pancreatitis.