Pain management strategies in pelvic exenteration: insights from a developing unit

Area of Science:

• Oncology
• Surgical Oncology
• Pain Management

Background:

• Pelvic exenteration (PEx) is a major surgery for advanced rectal cancer, causing significant postoperative pain.
• Effective pain management is vital for patient recovery, complication reduction, and improved outcomes.

Purpose of the Study:

• To evaluate perioperative pain control strategies in pelvic exenteration surgeries.
• To assess the effectiveness of different analgesic techniques and their impact on patient outcomes.

Main Methods:

• Retrospective review of 19 patients undergoing PEx for advanced rectal cancer.
• Data collection included demographics, surgical details, perioperative analgesic techniques (epidural, PCA, intrathecal opioids), and recovery metrics.
• Analysis of surgical duration, time to mobilization, and length of hospital stay.

Main Results:

• Epidural analgesia with patient-controlled analgesia (PCA) was the most common postoperative pain strategy (63.1%).
• Robotic and laparoscopic PEx approaches showed earlier transition to oral analgesia, earlier mobilization, and reduced hospital stay compared to open surgery.
• Chronic post-surgical pain occurred in 26.3% of patients, with risk factors including sacrectomy and opioid tolerance.

Conclusions:

• Pelvic exenteration pain management presents ongoing challenges.
• Standardized pain protocols and consideration of the surgical approach are key to enhancing recovery and outcomes in PEx patients.
• An institutional perioperative analgesic algorithm has been developed to guide clinical practice.