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Impact of epidural versus wound catheter analgesia for patients undergoing open pancreatoduodenectomy: A randomized
Piia M Peltoniemi1, Teija M Nieminen2, Hanna I S Belfrage3
1Department of Perioperative and Intensive Care, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Background:
Thoracic epidural analgesia (TEA) induces vasodilation which in open pancreatoduodenectomy may increase fluid administration, potentially raising complication risk. Continuous wound infusion (CWI) is an alternative, but procedure-specific evidence is limited. We compared TEA and CWI focusing on perioperative fluid management, norepinephrine consumption, and clinical outcomes.
Methods:
In this single-center randomized controlled trial, patients undergoing open pancreatoduodenectomy were randomized to TEA or CWI until postoperative day (POD) 3. The primary outcome was norepinephrine consumption on POD 0, reflecting vasodilation. Secondary outcomes included fluid administration, opioid consumption, pain scores, 90-day complications, and length of stay.
Results:
Of 434 patients, 116 were analyzed (58 TEA, 58 CWI). TEA was associated with higher norepinephrine use on POD 0 (3.7 vs 2.0 mg, P < 0.001) and greater fluid administration in the post-anesthesia care unit (4.0 vs 3.0 ml/kg/h, P < 0.001), but fluid requirements were similar between groups on subsequent days. Severe complications (Clavien-Dindo ≥3) did not significantly differ (TEA: n = 9[15.5%] vs CWI: n = 13[22.4%]; P = 0.48), and median hospital stay was 8 days in both groups. TEA provided better analgesia on POD 1 (NRS 2.4 vs 3.9, P = 0.004), whereas CWI patients reported lower pain scores on POD 4 (NRS 3.0 vs 1.3, P < 0.001). CWI was associated with higher early postoperative opioid use.
Conclusions:
In open pancreatoduodenectomy, TEA increases early norepinephrine and fluid requirements without affecting subsequent fluid therapy, complications, or recovery. Despite vasodilation with TEA and higher opioid use with CWI, both techniques yield comparable outcomes and are viable alternatives for pain treatment after open pancreatoduodenectomy.
Clinical Trial Registration:
NCT04668781.
